Dr. Youn asks, "Would it have been preferable for Jerry’s wife to see him sedated, peaceful and for her to cling to the slight hope that he might survive? Or would it have eased her loss to have had the opportunity to say goodbye, even if it meant seeing him in grave pain?"
It sounds to me like Dr. Youn believes that Jerry's wife would feel more hopeful of her husband's survival if he appears peaceful on a ventilator than if he were writhing in pain.
Seeing a loved one in pain is distressing. But the patient's appearance is not a primary driver of hopefulness -- and it shouldn't be.
Most family members look to physicians and nurses to guide them: "Is my husband's being intubated a good sign or a bad sign? How much hope is there, Doctor?"
Doctors can explain the patient's statistical chance of recovery. They can share what they know of the patient that might work for or against the patient's recovery. They can share their experiences with past patients who recovered from similarly grave circumstances.
If a doctor says, "A situation like this is not hopeless," most people will muster some hope.
The family that understands what is being done -- and why -- sees the awful-looking procedures and medicines as "hope."
In my next post I'll address the issue of letting family members say good-bye to patients who are suffering.
This is a difficult issue, and depends much on the personalities of the family members. I would think they would be more hopeful if they saw the patient on a ventilator and in peace than in obvious pain. It's important that the doctor and family members communicate in a way that is productive and honest.
Jan
Posted by: Jan Hasak | July 27, 2011 at 01:40 PM