A church member had passed away 1+ week ago. He was a case of lung cancer with brain metastasis. He had joined our church 1+ years ago months after he was diagnosed… A simple man with no “carcinogenic” habbit, non-smoker + non-drinker; he worked as a clerk in the land office. I did not have any close contact with him initially but later on he had gone into coma after a severe pneumonic episode. He was admitted to hospice ward in the K metropolis (previous K county but later merge with K city and become K metropolis). On most of the Friday night, I used to travel to the hospital bringing his children over to see him. After a miracle recovery, he was still in coma though but he was transferred to a smaller hospital as the National health insurance prevented for him to continue for staying in the hospice ward(in the same hospital) after he was stabilized.
Weeks later, he had suffered from a diarrhea episode and his wife had accepted our suggestion to stop the milk feeding and switch to soy bean and grain base liquid diet. Another miracle occurred as he had regained conscious and able to communicate. However he was still paralysis due to the brain metastasis.
His wife had tried every possible excuse to keep him in the hospital as the insurance claim was RM 300 per days for admission. After a wild goose chase of moving from 1 hospital to another, they had decided to return for home care.
They had hired a indon maid but unfortunately the wife had misused the maid. She had asked the maid to help out with the house hold job instead of staying beside the brother and taking care of him…He had vomited while the maid was working back in the garden planting tomato he had choked and aspiration pneumonia was noted.
He was very dyspneic later on and the families were unbearable to see his suffering and sent him for admission. He was admitted to ICU in my ex working place. Do-Not -Attempt-Resuscitate order was signed on admission by his wife.
It was a hard decision for me when the wife and mother had seen his condition worsening on D2 - he was experiencing severe shortness of breath. They had asked me for opinion regarding intubation. Unlike working in the ED, the opinion was though. The ICU did not provide any strong sedation and narcotic for the patient despite of the 40-50/min tachypneic condition. Under the counter, the mother had complaint to me that the wife had asked the maid to leave the patient for some gardening job leading to the pneumonic episode….
I had recommended for intubation as the aspiration is an acute episode hoping for recovery after antibiotic therapy. That could also buy some time for the mother to undergo her anger…. The wife forfeited the DNAR order and proceeded with intubation.
Despite some improvement on D3, the patient had gone into severe respiratory failure c high O2 use. He finally passed away on a morning....
It was a difficult choice for me to give such recommendation. I was standing on the side of the family despite of the patient… from the point of practice, it is against what I believe… but still watching your relative in a stat of shortness of breath and passing away is something very suffering….
Well, anyway with the grace of LORD, things just went fine and everyone were happy….excluding me of coz…
I had wandered what would be my decision when the time comes for me to decide…
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