Wednesday, September 21, 2005

Comfort Measures

As the week progresses, my patient with stomach cancer declines. The progression of his illness over the past few days has necessitated conferences with the family and health care proxy, meetings and phone calls, and finally a decision yesterday to institute "CMO" status: Comfort Measures Only. This means we have withdrawn IV fluids and IV antibiotics, ceasing all discussion of how to stem the growth and ferocity of the cancer. He is now simply on morphine and oxygen, with a urinary catheter inserted. Death is certain, perhaps within 2-3 days.

The family took it well, although there are several members who were not present for our discussion yesterday afternoon and who will need some education. Hospice nurses are coming to the hospital this afternoon to meet with me and the patient's health care proxy/caregiver, and we will initiate a transfer to home for the late afternoon if all goes well. There he'll be surrounded by family and friends who will be encouraged to maintain a peaceful and quiet atmopshere. Hearing is said to be the final sense to be lost prior to death, so even if the dying person seems to be unconscious, it is a golden opportunity to say anything that has been left unsaid.

Things have moved along at a rapid pace for this lovely gentleman, but the care which he is receiving is motivated by love and a deep respect. I assume he will not survive the week. I too will say my good-byes......
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