I'm looking for some advice for those cases where you've got some time (<30 minutes), but not much. They are needing tubed for worsening whatever (clinical details not relevant aside from the fact they are able to struggle but converse).
You hope everything will be alright but you have a sinking feeling it probably won't, and it will be the last time the patient is awake and able to speak to their family.
Do you tell them this might be a last goodbye and scare them?
What do you say that conveys the gravity of the situation but also affirm that it is not an end of life situation… but it may well develop into one and there is an uncertainty in critical illness. I don't usually see my colleagues offering a moment with the patient and the family when if you are organised you could give them like 5 mins max when you get ready.
Personally, if it were me I would know obviously because of our work so I would tell my loved ones I loved them but patients often lack that insigh into the severity of their disease or their prognosis is uncertain due to other factors. A lot of the times it's all just reassurance: "everything's going to be fine, see you in a couple days when your lungs are better etc etc".
I've tubed a lot of people in these semi emergent situations and i often regret not allowing them this opportunity. I find the reassurance method works fine but when you know yourself that it might be fatal, i feel like ive stolen a moment from the family they could have had. Obviously these are dynamic time critical situations so having the time to do this is a luxury and sometime you just need to get on with it. I am talking about the situations where it is possible and you do have a very small amount of time.
I don't want to terrify them or their families anymore than they already are, but those last moments (if they are the last ones) are precious and I think having a prepared chat to highlight this without coming across as an end of life discussion would be good.
Does anyone have this conversation with their patients and families ? What do you say?
Source: Original link