half measures

the patient has been in hospital for three months, in and out of icu for most of that. a young bloke, he went for a drive on his birthday with his nephew and they smashed themselves up good: broken bits, burns, the works. he has been making slow slow gains, his grafts and regrafts are mostly not taking. he is on tpn and ng feeding but remains cachexic. he is withdrawn and rarely engages. he hasnt moved his right arm for weeks and his left fractured femur is held together by metalware but hasnt made any attempt to form a callus after all these weeks. looking at a double amputation, weeks more in icu, months of rehab and years of recovery, his family have decided to pull out.

my consultant told me he was a bit surprised because he felt the patient had been making gains. but he could understand where the family was coming from. so the plan is to withdraw treatment, and quickly. he told me he didnt like to do thing by half measures. the patient could die by a thousand cuts, slowly succumb to infections and malnutrition over days and weeks. or he could die with dignity. we would turn the sedation up to ten and ten of morph and midaz per hour initially, then titrate upwards freely. three days later, we'd turn the ventilator off, knowing he'd be comfortable and lapse into apnoea.

i don't know if i agree. this seems to go against everything i believe in about medicine, about palliative care, about my role as a doctor. and yet, there is something dangerously seductive in what he says. it feels both right and wrong...