Based On Sound Evidence

The worst thing that physicians can do is just give something new a try, without anticipating possible consequences. Availability remains a major issue. Care priorities based on sound evidence and proof also are essential, as is palliative care. Ideally, we all should be aware of the facts in order to discern what might be helpful and what might not. Trying everything isn’t always the wisest plan, and families need to be warned that some therapies and interventions lack a scientific basis and are contrived and even coercive. Additionally, some interventions are prohibitively expensive and could potentially bankrupt families. It’s a crucial task for physicians to judge these claims on their merits because so much is at stake. Chances are, you’ve left a hospital room or conference forgetting to ask an important question. You may have been unsure what to ask, or perhaps you were uneasy bringing up a certain topic. It happens all the time. I understand that families often feel overwhelmed when meeting with the team that’s taking care of their loved ones, particularly if many staff members are present. Families may view such meetings as coming to terms with the writing on the wall.

You're Never Alone

This isn’t always the case. Doctors use family conferences to share what they know, anticipate loved ones’ questions and concerns, and, above all, provide transparency. During these meetings, family members may be at a loss for words or leave the meeting with feelings of unresolved business. In this section, I’ve compiled a list of 25 questions I’ve been asked. I hope the answers can help families better understand a loved one’s condition. Not all questions will apply to every family’s situation, and some have to do with very specific circumstances. Can someone who’s comatose feel pain? How about someone who seems to have some awareness? Brain injury often affects the areas of the brain that connect feeling and affection with pain receptors. Some individuals who are comatose can only feel pain after regaining some degree of awareness. If a patient is showing signs of improvement, a physician may recommend early pain treatment. When doctors are uncertain as to the pain sensations felt by someone who’s minimally conscious, we assume that the individual’s capacity for pain is close to normal. So, we’ll treat the pain because that’s likely to do less harm than ignoring it. However, it’s very questionable to treat a deeply comatose patient for pain when the person undergoes a medical or surgical procedure known to cause physical pain because there simply is no awareness.

Don't Change My Mind

Why are food and liquids not given to someone receiving palliative care? Won’t the person get hungry or thirsty? Neither hunger nor thirst registers in patients who are comatose or who have a devastating brain injury. Many patients who’ve recovered some level of consciousness also may refuse to eat or drink even when it’s encouraged. Their minds have changed to such a degree that hunger and thirst are secondary considerations. They’re often more preoccupied with discomfort. In someone with a devastating brain injury, after withdrawal of nutrition, fluids and medication, death is peaceful. However, decisions are far more difficult if a patient has had a feeding tube for years. Suddenly removing the tube seems intuitively cruel, and family members may disagree about removing it. These disagreements may become extreme and uncompromising and can even end up in court cases. This happened with Terri Schiavo. Several physicians said she was very much awake and may experience normal sensations of hunger and thirst, but they based it on edited videos of Schiavo and never examined her. Many experts in neurology were unconvinced because there was no other evidence that Schiavo was conscious. The situation quickly became a political and media circus, and the courts ultimately granted Michael Schiavo’s request that his wife’s feeding tube be removed.

Meeting Your Match

In my experience, I have often been able to resolve disagreements by taking the time to explain in detail why removing a feeding tube isn’t inhumane and sometimes is the right thing to do given the previously stated wishes of the patient. We keep hearing the term medically induced coma. Could you explain it? It’s unusual for a patient to be placed in a medically induced coma. What we mean by that is a patient is purposefully placed in a deep state of unconsciousness with the use of strong sedative medications. This may be done after cardiac arrest, when a patient’s body temperature is lowered to 32 or 36 C in an attempt to slow brain metabolism and help protect the brain. During cooling, sedative medications are used so that the patient is unaware of the temperature drop and doesn’t shiver. Sometimes, coma is medically induced so that a mechanical ventilator can provide breaths without the patient fighting the ventilator. Once sedative drugs are withdrawn, most patients awaken quickly and do well. Sometimes, awakening may take many days because the critical illness that brought the person to the hospital is affecting other organs, such as the kidneys and liver, and it’s taking longer to clear the medications from the body. It’s also possible that a patient may remain unconscious after medication withdrawal due to injuries. A worrisome practice on the horizon is measuring coma with tests rather than through physical examination. But just because we’re able to see some activity doesn’t necessarily prove there is conscious comprehension in a person who’s comatose. We’ve heard that tests for street drugs and other substances that are toxic aren’t reliable. Toxicology screening is useful, but physicians understand it has major limitations. It’s simply not possible to screen for every drug, and many drugs can’t be detected in blood or urine. Also, each hospital laboratory may do toxicology screening differently. Testing for barbiturates, acetaminophen, alcohol, salicylates and tricyclic antidepressants is common, and many drugs fall into one of these categories. However, what family members can tell us about a patient, such as whether the person has struggled with addiction, is often more important than what we can learn from a test.