A good piece, on the risks of euphemisms in medical notes, and some alternative ‘bubbles’ speaking the truth, some of which are quite funny, most of which make more sense. Sample of one of the more empathetic ones:
Man, 98, is pleasant and charming, and is brought from the nursing home at his family’s request. He has been having severe chest and abdominal pain for several days, and now has a low blood pressure in the 70s. His family wants “everything done.” The patient is lucid, and despite his pain is telling me about the time he felt the same at Guadalcanal when he was gravely wounded. He tells me he does not want tests or surgery, and is “ready to go.” Family is tearful, as I would expect, but desires that if anything needs to be done he be transferred to the teaching center in the next town.
This man likely has an aortic dissection. He has pulse deficits, and now has developed neurologic deficits. He is unlikely to survive any surgery. I have explained to his family that a man who lived heroically does not want to die pathetically. I will observe his wishes and keep him comfortable. I have spoken with him at length, and he has told me several stories I will never forget. The world will be poorer, but I will not subject him to anymore intrusion. His family will have to accept his wishes.