Friday, July 29, 2011

Bucket List For End Of Life Care

Sometimes it seems that nobody in America is allowed to die with dignity. All doctors have witnessed the sad and painful ending many patients suffer through before they reach their final resting place. Even with an advanced directive in place, that piece of paper can be overridden by an anxious and persistent relative. So I present to you the bucket list for dying patients, procedures that are almost universally practiced on these poor souls during their final moments on Earth but with virtually no hope of improving their prognosis.

1. ICU. Because nobody should die in the comfort of their own home or bed.

2. PEG Tube. Nobody is allowed to die on an empty stomach either.

3. Endotracheal intubation. Horrible for family to see a patient gasping for his last breath.

4. CT/MRI. Everybody deserves one last blast of radiation or a four figure imaging study before they pass away, just because we can.

5. Foley Catheter. Can't get up to the bathroom when tethered in bed to all the lines and monitors like Gulliver in Lilliput.

6. Endoscopy. Because the doctors can't figure out why a patient who has been in ICU for three months is having anemia and failure to thrive.

7. Echocardiogram. Because the doctors can't figure out why in a ward of sick patients, the patient is having fever. Inevitably when the echo tech says the transthoracic echo is of poor quality the patient will then undergo an invasive transesophageal echo.

8. Multiple subspecialty consultations, minimum of three. When the expertise of the internist or intensivist just isn't good enough to assuage the relatives. Still can't understand why nobody stays in Internal Medicine anymore?

9. Acrimonious family meeting. Because the reality of bad news is so hard to take for some people.

10. An all hands on board, rib-cracking, chest-thumping, vein-puncturing, drug-pushing, heart-shocking, final shot at life. Because we doctors have to show we care.

As we all inevitably shuffle off into our old age, this is the fate many of us will face in the end.


  1. I guess what you just mentioned would apply to patients who are already terminally ill, but for those that can still be saved such as those that is having a heart attack is a different matter.

  2. I can understand why we, along with the medical practitioners would want to do everything to prolong a love ones life, but what we fail to realize is that by doing so, we might also be subjecting them to more pain, such as in the case of terminally ill patients and those that has been declared brain dead.