Thursday, June 9, 2011

The most difficult decision: Palliative care

I was peripherally involved in a patient with end-stage heart failure. We were consulted for hyponatremia. The patient had a sodium on 120 which we helped increase to 130. During our involvement, the family was wrestling with choosing palliative care. The patient was frail with advanced dementia.

The patient ultimately died in the hospital before being made comfort care. The family was relieved that he passed. I was struck by the question, that if the family was so relieved that he passed why was it so difficult to decide on palliative care.

In all the intensity of care conversations I have been involved in, I can't remember the principal asking the family to imagine how they would feel if that got a call from the hospital that their loved one had passed. And then add, that if the feeling is one of relief, that hospice, or DNR, or palliative care, is probably the right decision.
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