A 66-year-old is 6 years out from a heart transplant. He presents with endocarditis of the aortic valve with fistulae into the right atrium and the pulmonary artery. He has an abscess around the aortic valve. He also is in renal failure neccesitating hemodialysis and has mental status changes. The patient is taken to the operating room where after several hours later, attempts to replace the aortic valve and ascending aorta fail. He passes.
A 23-year-old with a history of meningomyelocele, who is s/p VP-shunt placement shows up in the ER due to malfunctioning of the shunt. It has apparently stopped draining. At presentation, the patient was unresponsive and was in pulmonary edema. Prior to arriving in the OR for revision of the shunt, the patient arrested and was successfully resuscitated. She is however now posturing. Even after placing a drain to relieve the pressure, the mental status does not change. The family insists on everything being done. The medical staff obliges. Vasopressors, nitric oxide, the works. Four days later, with no improvement in sight, care is withdrawn.
All across the US, healthcare dollars are being spent on cases that are best described as futile. There is the ‘the-doctor-saved-the-day” attitude that forbids physicians from seeing the reality of the situation. Then also is the fear of legal action. Physicians are not willing to give patients and their families an honest and frank opinion. Whatever it is, we cannot afford to keep spending money that way. We either start policing ourselves or Universal Helathcare is going to force us to rethink our ways.
