Listening To Your Patient

I walked into preop to see my next patient. He was a centenarian, weighing all of 120 pounds. He had been cared for by his family at their home and it showed. The poor man was literally all shriveled up. He had horrible contractures of all extremities. Needless to say he had a nasty decubitus ulcer too. Why was he coming to the OR? He was scheduled for an EGD and feeding tube placement.

When I saw this poor man, I thought "Why?" He was nonverbal and confused. Of course he could not consent himself for the procedure so the family signed the order. While I don't normally advocate euthanasia, I thought this case would have been ideal. This poor man was not living. He probably hadn't lived in years. He was merely existing.

Under anesthesia, the patient did very well. That's one thing I have noticed about centenarians; they have relatively healthy cardiovascular systems. Otherwise they would have died a long time ago. The endoscopist performed the EGD and passed the nasojejunal feeding tube. It was not without difficulty as the tube kept wanting to slide out when he tried to withdraw his scope. When it was finished, the tube was taped to his nose. That's when the nurse noticed that most of the tube was curled inside the patient's mouth--the patient had used his tongue to pull it out. So the doctor passed the endoscope back down into his stomach. This time to ensure that the tube would not come out, it was clipped to the jejunal mucosa. He again withdrew the scope. The patient was then taken to recovery.

In the recovery room, the nurse noticed that most of the tube was once again curled up inside the mouth. Despite the patient's diminished mental state he had used the only defense mechanism he had, his tongue, to remove the feeding tube. Needless to say the endoscopist was extremely frustrated. He said he'll need to go talk to the family about placing a more permanent PEG tube so the patient can't pull it out. I thought, "Man, listen to your patient. He is telling you exactly what he wants and needs." He is scheduled for his gastrostomy tube next week.