Thursday, December 13, 2012

How much time?

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.

14 comments:

  1. Awww my mom turns 60 on the 16th. She can't believe it, cos she doesn't feel 60. The hospital/clinic more often than not, makes me full of gratitude.

    ReplyDelete
  2. Yay mom.. my mom will be 50 soon not sure how she feels about that.
    :-)

    ReplyDelete
  3. Congrats to your mum. I have that feeling watching Grey's sometimes. I hope your patient gets his act together and maybe get enough time to go on the transplant list.

    ReplyDelete
    Replies
    1. It doesn't look good, Myne. Even if he gets on the transplant list, his MELD score is not high enough at 24 for him to get first dibs. Lets not forget you have to wait for someone to die (or if you are lucky enough find a living donor) to get an organ. Plus, the fact that he is an alcoholic, doesn't help his case. Cos even after you are clean for 6 months, they still have to discuss IF you get on the transplant list or not. Being clean for 6 months is not a guarantee to get on the list.

      Delete
    2. Hmmm...I knew it couldn't be easy, too much hollywood I guess :)

      BTW, would be cool to know what you think of Grey's. The current season has some fresh interns. One reminds me of you :)

      Delete
  4. This feels like watching Grey's Anatomy...so sad.
    Happy birthday to your mum.

    ReplyDelete
    Replies
    1. I only watched d first season of greys. I hv no clue about that show. It will be interesting to watch to see how realistic it really is.

      Delete
  5. Its a hard thing to say to a patient, and like in the movies perhaps, he may get lucky enough to be eligible for a transplant. and happy birthday to ur mom. as for me, i dont know when my mom was born and probably neither does she.

    ReplyDelete
  6. Happy Birthday to your Mum! It's just so good to be alive..
    I remember not long ago I lost a close close friend cause his liver was beyond hope and to think alcohol caused it..

    ReplyDelete
  7. Happy BirthDay to mama... pls make sure u send me regards...

    ReplyDelete
  8. Many happy returns of the day to your Mom. 60 is such a perfect age...the threshold of graceful aging :)

    Why does putting a time/limit to a person's life feel like a self fulfilling prophecy? i am wont to believe that kills any zest to live. But, I am a firm believer of choices so there flies my theory!.

    ReplyDelete
  9. Happy Birthday to your mum. SO sad about the patient. It must not have been easy for the doctors either. God grant you his strength, my dear.

    ReplyDelete

Note: Only a member of this blog may post a comment.

Hey guys, welcome to my blog. Sit back, relax, grab a cup of coffee and enjoy!

  © Blogger template Writer's Blog by Ourblogtemplates.com 2008

Back to TOP