I thought my blog posts would all consist of me telling you guys crazy, bloody, nasty stories of things I have gotten to see in the ER. However, I have ended up learning and witnessing so much more than just some painful injuries. As I blogged about previously, I have been battling with the ethics of the doctors in the ER and their morals surrounding why they what they do. I saw myself begin to fall into the black hole that is doctor-hood, where the 12-hour night shifts cause the objectification of patients.
The other night, I had another moment where I saw the sides of being an ER doctor that didn't have to do with stitching a wound or resuscitating a patient. A 93-year-old woman was brought in by ambulance, picked up from a nursing home where she fell out of her bed in the middle of the night. I walked in with Dr. Rose and saw a sweet, tiny old woman laying on the bed, clearly in horrible pain. We learned through a phone call with the nursing home that she had Alzheimer’d Disease and that before this fall, she could usually walk with a walker. She was brought in on a hard board to support her back. She was strapped on tightly and the paramedics left her laying on the bed with the board still attached to her. With one look at her skin, the irritation from the rough board was clearly causing irritation. I was instructed to put on gloves and I, along with three other doctors, undid the straps before rolling her onto her side to pull the board from beneath her. Her scream for help indicated how badly her hip was injured. We quickly checked her lungs and spine before rolling her back off her hip.
With an X-Ray, we saw that her hip was severely broken and displaced, as shown in the photograph below:
There was no wonder why she was in such pain. Without a doubt, she needed surgery if there was any hope of her getting out a bed again. However, we found on her records DNR-CC, which means do not resuscitate, comfort care. Our patient had asked for her doctors not to take extreme measures to protect her health, but she did want to be kept comfortable. It was us - her doctors - to figure out how this applied to this situation. Any surgery is risky on a woman of her age, and it may full under extreme measures. However, how would she be kept comfortable with such a displaced hip? Another thing to keep in mind was her quality of life previous to the fall. Considering that she was able to walk with a walked before this, her quality of life would be drastically changed without this surgery. A lot of ethics came into play with this decision, which is something that I had yet to experience in the ER.
This woman, with Alzheimer’s, was not able to make this decision for herself. What was the right thing to do? How did her DNR-CC apply to this situation? The fact that she was previously able to walk is what helped our decision - she had the surgery that morning. This situation was a whole other side to being an ER doctor.
That is a very interesting point of view to see from the doctors perspective. At first glance, I would have immediately assumed that they would go through with the surgery in order to fix her hip and allow her the opportunity to heal. In addition to that, I personally thought that DNR-CC solely applied to instances where patients require being put on life support. (I guess Grey's Anatomy did not do this term justice). However, it is interesting to see all of the points put into considering upon deciding a path of treatment for each individual patient that comes into the ER. Overall, your experience seems to be teaching you so much not only about medicine, but what it takes to be a doctor. After seeing all of this, has your desire to become a doctor increased or changed in some way? Also, after hearing about all of the changes that are currently occurring in the medical field, does your sponsor recommend that you go into medicine?
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