Case studies provide a way for us to analyze and think-through difficult medical and moral situations. The links below will take you to stories that will challenge you to think clearly as you consider options at the crossroads of decision.
Twenty-nine year old Janet and her husband Jack were driving home from her ob-gyn appointment when tragedy struck. Another driver, elderly and distracted by an incoming text message, ran a red light and T-boned Janet and Jack’s Mini-Cooper. Both young people sustained severe injuries.
One day, a patient comes to see her complaining of ankle pain on his right leg. The patient is a farmer and says that he fell while he was taking care of his chickens in the chicken coup. He has some cuts and bruises on either leg, complains of a swollen right ankle, but appears to be fine otherwise. Dr. Contadina instructs him to purchase an air cast at a pharmacy along with some ibuprofen and to take it easy.
I had never seen it before. I had no experience on which to base my unsettling suspicions. And yet, it was unmistakable. My patient, Ms. P, was dying right in front of me.
JD is a 25 year old patient who sustained massive head trauma and neurological injury in a motorcycle accident. He is not brain dead, but after 4 weeks in MICU and several neuro consults, the prognosis for “meaningful recovery” is said to be less than 1%. JD has not regained consciousness and is apt to remain permanently in a vegetative state.
Kate is a 17 year old patient, unmarried and 8 weeks pregnant. She is a rather remarkable girl in that she lives independently while still a senior in a high school. She tells you that she was an adoptee given back to foster care and then abused in that system.
A forty-five-year-old man with a three-year history of cardiovascular disease has entered the hospital with a stroke that has paralyzed his right side and caused him to aspirate food of any consistency. His mental status is clouded and there is disagreement as to whether or not he has decisional capacity. His language capacity is only “yes” and “no,” and his responses are inconsistent.
There are such emotional overtones to this case that it might be helpful to use Immanuel Kant’s recommendation: What if everybody performed the action with the same purpose in mind?
The doctor explained that for Mr. Jay attempting resuscitation following a pulmonary arrest was not likely to succeed. The doctor further explained that even if resuscitation restarted his lungs, Mr. Jay would require aggressive care in an intensive care unit. Given these prospects, Mr. Jay told his doctor he would prefer that resuscitation not even be attempted.
What should physicians and families do when the patient they are attending is in the dying process? The answer may not be easily categorized, but one thing is certain: the failure to communicate will always have grave consequences.
Alice watched her mother’s long slide into alzheimer’s type dementia, certain that her mother’s careful attention to advance care planning would be able to prevent her worst nightmares. . .
Almeda’s nurses and attending physicians want her long-time friend Barney to help them determine the direction her treatment should take now that she needs dialysis. She’s already on a ventilator, a feeding tube, and receiving high doses of antibiotics. She would be better, Barney thinks, if she could watch TV a little. . .
Providers and family members alike must tread carefully when caught between a patient’s crankiness and a family’s report that the patient’s pain is not being managed.