Mrs. Chee’s ER experience
This is a summary of the story about an 80 year old patient written by ER physician Tony Dajer.
It was published in Discover Magazine (3/13/07).
Mrs. Chee was rushed into the ER: altered mental status, no palpable blood pressure. Medical history: Renal failure - dialysis 3x/week for the past 10 years; hypertension; pacemaker; history of stroke. Blood tests revealed high potassium. Dr. Dajer warned her son, a fellow physician, “The treatment we can give her for dangerously high potassium can kill tissues if it leaches out of a vein.” Mrs. Chee received calcium chloride, insulin, glucose. She seemed to do better, but then, “Mrs. Chee gasped for breath, her wizened head bobbing with the effort”. The distress resulted from the fluid overload of the medications they had injected. “Because her kidneys don’t work, the large volume of fluid had nowhere to go but her lungs.” Meanwhile a second dose of calcium was given, causing Mrs. Chess’s hand to turn a “sickening purplish red color”. Asthma medication was given to dilate her airways. While waiting for dialysis, nurses were instructed to "give her all the Kayexalate by enema that you can"
A plastic surgeon checked Mrs. Chee’s hand which was now "frozen into a blistered claw," needing immediate surgery. They cut into the fascia (wrapping of the forearm muscles), releasing underlying flesh and restoring blood flow. Her poor circulation and high doses of calcium had caused the swelling, blocking off blood supply to her hand. Meanwhile “surgeons managed to get large-bore lines into the vein under collarbone to use for dialysis.... Somehow, she pulled through the night.” It turns out that eating a high potassium durian fruit, a delicacy of SE Asia, had thrown Mrs. Chee into this crisis. The article didn’t mention anything about the follow up care needed immediately after hospitalization, but a fragile 80 year old would have had a hard recovery after that amount of trauma.
As we read this account, some will marvel at modern medicine. It prompts Boomer Optioneers to ask:
- Why did they automatically use heroic measures "to save" an already long life, a life that already relies on a lot of medical intervention?
- Why didn’t this physician consider the total health status of this person?
- Would he have recommended and performed all the procedures if she had been uninsured?
- Was Dr. Dajer fearful of legal implications if he didn’t do everything possible to prolong her life?
Perhaps the most important questions should be asked of Mrs. Chee’s son:
- Was she holding on to life to be present for an upcoming family milestone?
- Did his training as a doctor alter his view of the life/death cycle, so that he was compelled to encourage his mother to “fight” for life once again?
- Had she ever articulated when enough would be enough?
- Would she have consented to all these uncomfortable procedures if she had been fully conscious?
- Wouldn’t slipping quickly into death, at home, after eating a nice treat, be a pretty good way to go?
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