Ethics

This was a busy week at Cayuga Med. I've been seeing many patients on my own, obtaining a lot of diet histories, doing countless coumadin/vitamin K educations and writing plenty of notes. This week I attended my third and final diabetes education class that takes place at an outpatient physical therapy/rehab center down the road. I thought the lessons did a great job of preparing newly diagnosed diabetics about managing their diabetes. I also observed a barium swallow on a young (48 yo) man who reports occassional choking over the last 2 years. His swallow eval showed no abnormalities, however.

Of particular interest is a case that I have been following since day 1 of my internship. HA is a 73 yo male who was diagnosed with metastatic lung cancer in February of 06. He has been in the ICU intubated and with an NG tube in place, unresponsive for nearly 60 days. There has been somewhat of a stalemate between family and staff regarding further care of HA. Before HA became unresponsive, he had indicated on several occassions that he wished to not be on a feeding tube or intubated. However, his daughter was named as the health care proxy and strongly disagrees with this and does not believe that this is her fathers wish.

There have been numerous discussions between the family and staff about what is best for this patient. The family disagrees with how the staff is treating themselves and the patient, claiming that they have been disrespected, discriminated against and intimidated by security. On numerous occassion security has been called in because the patients daughter yells at staff. Yesterday a family meeting was held with the administration, staff and family regarding further care of HA. The family does not believe that CMC is doing everything possible to improve his quality of life and they want him transferred. The staff has explained the reasons why HA should not be intubated and on a NG tube for this lengthy period of time. However, several weeks ago when placement of a PEG and trach was discussed, surgical did not think this was safe as HA's tumor was beginning to obstruct the airway and displace the trachea. I am interested to find out how HA does following these procedures.