Sunday, July 22, 2012


   The God has kept certain things in his ( or her ) hands . We can not decide the of birth ( though with c section to some extent we can ) or death . I often talk about this in various ways . " When spring unwinds completely , then we die ". Or ,"It is related to our previous karma , that are going to come to fruition , once that is done , we die ."and many other.The story that I am going to tell one related to this part .
    James was my patient for many years . His son was a policeman and the daughter in law  was a nurse in our hospital .He had advanced COPD , the emphysema , that was a result of several years of smoking . He was on oxygen , most of the times and was short of breath on walking couple of hundred feet. At times he used wheel chair. He was admitted to hospital several times . I had talked to him and his wife , as well as to the daughter in law about the advanced disease and DNR status , especially the respirator . I knew that if he goes on respirator , he would be very difficult to be weaned off it , and we will be talking about 'trach' and then may be discharging to a nursing home with the respirator.As usual the answer was 'I will think about it '.
     As it happened , he was admitted to the hospital with the shortness of the breath. This time in spite of the treatment , he continued to get worse and I had to move him to ICU. I tried everything , but he continued to get more short of breath . No decision was made on the respirator. So one late evening he was put on the respirator. As the time passed on we could not wean him off the respirator and so now the talk of doing trachostomy were done . The family was not sure , but only other option was to the withdrawal , which meant discontinuing the breathing machine . This would certainly would have caused demise , and the family was not ready . ( This is common problem, as we can decide not to put patient on respirator , which is less painful or traumatic than so called 'pulling the plug ').
     One late night I got a call from the ICU. James had a cardiac arrest . As it happened , there was cardiologist in the ICU and he conducted the code and did every thing to help , but James did not make it . I talked to the nurse and got the telephone no. of the wife and the daughter in law . I decided to call the daughter in law . I thought it would be better to tell her than the wife . I told her what had happened . She had pushed the mother in law in past to make James DNR. But the decision was never made . She told me that she will get her mother in law and come to the hospital,as they lived only couple of miles away. As soon as I hung up the phone , I had call from the ICU. When I called them the nurse came to the phone , and said ,"guess what  . " I was in no mood to do that at 2 am . So she continued , 'James is alive  ' 'WHAT' I asked . Then I came to know that once the cardiologist pronounced him dead , when the nurse went to his room to disconnect the lines and the monitor  she noticed that he had started breathing and heart rate was 45per min . So she decided to put him on the respirator. I told them to call me when the family came in . It was in next 10 mins. that they called me again . I talked to the daughter in law . She had told the mother in law that he had cardiac arrest and not told that he had passed away . So when I told her the whole story , she the daughter in law made the decision on DNR. ,to which his wife had agreed .
       James lived for another 2 and half days . So this why I feel that one can not predict the time of the departure .

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