Multi-staged death.

Been mulling the wise post over at St. Emlyns about little white lies.  http://stemlynsblog.org/2012/09/little-white-lies-in-the-resus-room/

Then was having a discussion with a local vet about breaking bad news. He told me about his favourite method which he calls the multi-staged death.

So he will often get a cat/dog that has been hit by a car, usually arrive with a distraught owner who asks for him to do everything possible to save them. Firstly he explains its touch and go and that they should say their goodbyes and go home. Then he does what he can for the critter.

If it goes badly and they don’t survive or if the injuries are simply unsurvivable he initiates the multi stage death protocol. Sometimes  he will do this  after the animal has passed away.

(Stage one) First his nurse calls to tell them it’s not looking good. This gives them an early warning about the likely outcome.

(Stage two) A short while later he calls to tell them he’s going to take their pet to theatre and he will “Do what he can” further preparation of owner.

(Stage Three) Then finally he calls back and breaks the bad news that despite all the best efforts the injuries were not survivable. Gives closure, they feel all that could have been done has.

He swears by it as being a great way to prepare the owners for the likely outcome and is much better than the “Will call you when its done, either way” approach of his practice partner.

Now im not advocating this approach for patients but found it an interesting approach. Thoughts?

 

DF118*

Another yarn, promise more proper cases soon.

We recently had a patient through whom is prescribed I/M pethidine at home for pain control. has episodic pain secondary to renal stones from medullary sponge kidney. We were all pretty uncomfortable but there was multiple letters from pain service and local anaesthetic service r/v as well. so to be honest felt pretty off but just prescribed as per “protocol” whilst they were in.

Go us to talking about chronic pain and difficult patients. Locum physician whos got a few grey hairs told me this tale.

He moved to a small rural town with a little hospital as one of his first general physician jobs.

His first patient to see in clinic was a lovely old lady with chronic pain from cervical spondylolisthesis. She had been on DF118 for almost 12 years with good results, no real complaints of pain. Her GP had passed away and the others at the practice felt that this was not appropriate and she was sent to see the physician to Review and decide on pain management. After long discussion he felt that continued DF118 was in order as she had done so well with it. But did not want to continue prescribing so wrote a script for 2 weeks and told her to return to her GP.

Later that afternoon he received a call from the local pharmacist. “What the hell are you doing prescribing DF118 for this old lady without the asterisk?” Confused He replied “excuse me?” The pharmacist went on to explain that the patient had been taking vitamin A pills for the last 12 years with good effect and that he knew to give the placebo to the scripts with the asterisk. Apparently the Old GP had a few tricks up his sleeve for those he felt needed some pain relief or at least thought they did.