Today we had to tell a patient he had 6 months to live. It was tough. Haven't you ever wondered how doctors come up with those numbers? In this case, since he is my patient i was assigned the task of getting the numbers. There's no magic calculator, it's all research. I had to go dig in the literature and i didn't have to do much digging because we already knew the prognosis for what he has is grim but we just wanted numbers.
He has End stage liver disease due to alcoholic cirrhosis, acute kidney injury due to acute tubular necrosis and hepatorenal syndrome (long story short, your kidneys stop working because your liver is not working). All that added together, based on research gives you a 50% survival rate at 1 month and 20% survival rate at 6 months. If you use his MELD score (which is used to prioritize people for liver transplant), his prognosis is 31% survival in 3 months. He is not eligible to be put on the transplant list because he only stopped drinking in Sept when his ascites started and his urine drug screen was positive for cocaine less than a month ago. You have to have been clean for 6 months, to even be considered to be put on the transplant list.
So we (or rather my senior) told him that he had 6 months to live. In reality it could be much less but my attending decided we go with 6 months because it's easier for patients to grasp that better than 3 months. At least that's what i understood. If his kidneys recover which is a possibility, he could have longer. Unfortunately once your liver is cirrhotic or damaged there's no chance of it recovering on its own. Either way, things don't look great for this man.
It was tough watching his reaction but i think even though we gave him numbers today, it was easier than the first time we told him things were not looking great 2 days ago, cos then he started crying and saying how much he wants to live and he is ready to fight. Today, you could see him struggling to hold himself together and look for any ray of hope. The one thing i have learned is that you always want to let your patients have hope, definitely not lie to them but let them retain some sort of hope while being as realistic as possible. I think my senior did a great job and i learned so much just watching her go through things with him.
Watching people suffer doesn't make me feel better about my lot in life instead it makes me want to do the best with the time i have that i am healthy and able to do things because i have no clue what tomorrow has in store for me, but it's hard. I'm struggling. Everyday is a struggle. 2012 has not been my year.
On a brighter note, my mom turns 60 tomorrow and she could easily pass for a 50 yr old. I remain thankful.
Wordless Morning Post
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