Ethics 200

I have this patient. She weighs 900lbs. Her fat is killing her.

She was admitted to hospital about 7 months ago with a leg infection. She only weighed 700lbs then, was able to get around with a scooter, and was very very unhealthy, but still living relatively independently.

Since she has come to hospital, she has gained 200lbs. How? By ordering pizza. By asking the nurses to bring her T-Ho's "Iced capps" or get frappucinos (extra whip) for her. By snacking.

She is no longer able to turn herself. She is so heavy that she cannot roll from side to side. She has developed bedsores. They are infected. This week, we had a discussion with her and her family about the fact that, should she have a cardiac arrest, we will not be able to resuscitate her.

Why don't we stop her from eating?

Because, in Canada, individual rights trump common sense (or medical experience). She is a human who wants to eat herself to death. We must respect her right to do this.

I have issues with this:

1. People who refuse food (anorexics) are considered mentally ill. We force feed them. This woman is literally eating herself to death. She is aware that her food choices are killing her, but she cannot stop eating. However, as food addiction is considered a life-choice (like alcoholism or smoking) we must allow her to continue.

2. Suicidal patients have their human rights temporarily violated until can be treated for their intention to self-harm. This woman's in-hospital weight gain is an act of self-harm. As such, we should be able to temporarily restrict her caloric intake until she has undergone psychiatric assessment and treatment.

3. She is not capable of getting this food by herself. She only gets these extra/unnecessary calories when hospital staff bring them to her. Just as smokers are allowed to leave the hospital to smoke, we could allow her to snack as long as she gets the snacks herself. We are enabling her by providing her with toxic food.

4. She is currently costing the Canadian health care system 10,000 dollars a day. Our socialist system does not have an unlimited budget. She is currently scheduled to stay in hospital until she dies, because there is no other facility that can hold or treat her. Even if we argue that her individual rights should allow her to kill herself, surely the collective rights of the Canadian people outweigh this. She should be restricted to a sensible diet until she is mobile can be managed in a less expensive facility where she is not taking a hospital bed from someone else.

Alas, I am not in charge. She will stay until her wounds become too infected, her heart gives up or she chokes on her own fatty tissues. This could be tomorrow, it could be next year. So it goes.

I miss the Australian medical system; I remember my boss saying, "I'm the doctor, I'm responsible, why should I let this bloody idiot kill himself under my care?"

Canadian medicine is too precious for my taste. I'll take common sense over individual rights any day.

Existential Crisis

Everything is heightened when you don't sleep. I've been on call for 72 hours in the last 5 days. Last night my pager went off at 5am and I woke to run to a Code Blue. 45 seconds from waking to pushing down on a man's rib-cage so hard that his ribs scrunched. He died anyways. It was truly horrifying, but I didn't have time to process it during the night. Today, I had nightmares.

Of course, this highly emotional state leads to big questions; what am I doing with my life? Am I making the right choices? Should I cut off all my hair?

I don't think I'll ever get convincing answers. And I don't know if it's better to roll the dice, despite your doubts, or to hold off and wait until you're sure. I've been alive for 31 years, and the only thing I was sure of, medicine, is making me question everything else.

Blah blah blah. Deep thoughts have no place in a post-call brain. Forgive the maudlin crap, I will be back and bright tomorrow. With proper medical tales to tickle your brain and poke your gag reflex.