let's have bizarre celebrations

i currently spend my days toiling away in the SICU (i may return to earlier events later). one of my patients is a 78 year-old woman who has been in the hospital since may. she initially came in as a trauma--according to the ED chart she tried to kick a box of kleenex out of her way and lost her balance and fell. she broke several ribs. being on the older side, and with a few other medical problems, she subsequently developed pneumonia, then sepsis, and things have not gone well for her since then.

skip forward to september. she is still on a ventilator and there is difficulty weaning her. she also has a huge hiatal hernia (meaning her stomach is in her left chest cavity) which is felt to be a possible contributor to this problem, as the left lung is much compressed by her ample stomach. during the surgery to remove the stomach from the chest there was a colon injury, and she wound up with a colectomy and end-colostomy. this is major surgery for anyone, recovery can be slow and is not guaranteed, particularly if one has spent the preceding 3 months septic in an ICU.

where she stands now: she has had repeated episodes of sepsis, is on some serious antibiotics, and her wound is not healing well. in fact, about 7 days ago it fell apart--literally. the skin incision broke open, and a day after that a brown-green liquid--enteric contents, ie, shit--began leaking out her abdomen and mouth. her blood pressure remains low, despite 2 medications that artificially raise it. she makes almost no urine, and her liver is failing. we are doing everything we can for her, yet her condition deteriorates daily. she will never recover from this.

why, you ask, does this continue? where is her family? someone to make her comfort care only and end her suffering? she has none. she is estranged from her only daughter--something about a suicide of a boyfriend the daughter blames the mother for instigating. instead, the patient has a court appointed conservator who gets paid for every day that she spends in the hospital. it takes him three days to call back every time we try to get consent for another procedure. he wants us to do everything we can; shocking.

as i was falling asleep last night, i was thinking of her. no one should have to suffer like that. i was trying to think of ways that i could surreptitiously hasten her demise and not get caught, thereby ending her suffering.

of course i would never actually do this. i unequivically state that i have no intention whatsoever of attempting to harm this patient.

the most execrable part of this whole situation is not that i had this passing thought, but that a system has been set up that allows her conservator to financially benefit from his malfeasance (read, inaction) while her condition progresses to such a lurid extreme.