My grandfather passed away approximately a year ago.
Today I decided to go through some of his items. I decided to thumb through some of his previous medical records in a file I found.
He is always been pretty private about his medical conditions. Didn't ask for much in terms of advise and….well I didn't want to ask too much since he didn't want to talk about it. He would always want to drink a Lone Star when I would come visit him and bullshit with me. So, we drank beer, ate some cheese, and talked about life / women / guns / cattle / religion (The Texas pentad as we can call it) . He was 87 when he passed away, had COPD on 4 L of home O2, A. fib, CAD with previous stents.
When I entered medical school and throughout my training his COPD really started advancing. He spent the last 3 to 4 years of his life more or less bedbound and could only walk between the couch and the bed without significant shortness of breath.
Thumbing through the records were a bit eye-opening. It looks like his primary care doctor was more or less giving him monthly to semi-monthly methylprednisolone injections, he had a sleep study done, he had 5 echoes outpatient, an MRI brain for tremors in his last year, he had for stress test EVERY YEAR in the last 4 years of his life, and had a few CT scans of the chest when he had bronchitis. Keep in mind, he could not walk more than 50 yards.
So with this I couldn't help but think of how everything could have went so wrong.
I remember having end of life discussions briefly while talking about religion with him and he would always tell me, he is ready when it is his time to go. But looking at the advanced directives portion of the primary cares note…..this part is left blank.
Even at the end of life this man was ready to go but had only talked about end of life care with my mother and my grandmother. My mother happened to have MPOA.
He fell, broke his hip and you all know the rest of the story. He was then intubated, was hard to get off the vent, sent to a LTAC and for weeks my family argued over how things would go while the brothers and sisters of my mother filed lawsuits against my mother since she was MPOA and my grandmother did not want to make a decision since they claim they never heard those wishes and that he was on benzos when he filled out any legal paperwork. Some of them kept leaning on data like his stress test looked good a year ago or his MRi brain was perfect a year ago.
In the end, my grandfather died of pneumonia, never woke up, and it ripped a family apart. Not to mention about 2 months worth of ICU stay.
I tried to speak up during this but only got pushed away and eventually legal contacts from their lawyers to basically stay out of this or else risk being sued and even a phone call where he threatened to report me to the board for offering medical advise without being the attending physician.
Looking through the bills from the hospital stay that medicare paid for, it totaled well over 200k for the last month of his life. That doesn't include the stress tests that were done and all the other Rxs he had prior to his death.
This whole situation has really hit home for me for my elderly patients. Now I don't wait to their annual physical to ask about advanced directives. I have seen first hand how it ripped an extended family apart and caused the slow painful death of a man who for years would tell me and my mother that he didn't want that.
I don't blame any particular individual in this case. Everyone including myself could have done better and in a way contributed to the eventual outcome. I just wanted to share my story for you fellow docs can put a bit of realness to what happens when shit isn't documented and hopefully it might make us all take a second look rather than clicking that button (discussed advanced directives with patient to hit those medicare metrics).
Source: Original link
