When admitted, his chief complaint was “cachexia.” However, his appearance when we saw him in the ED said volumes more. Thin, wasted, breathing laboriously, and eyes listless, this man was clearly a shell of who he previously was. On reviewing his medical records, the last 6 months were consistent with the same story: “unexplained weight loss, encourage more PO intake.” Also of note: “Patient full code, should switch to do not intubate/resuscitate.” Yet, the patient lying in front of us was gravely ill, undiagnosed, and still full code – the product of exceedingly negligent care.
A simple physical exam revealed a probable cause of his symptoms – a massive inguinal lymph node, greater than 5cm in diameter, nearly protruding from his skin. We promptly sent him down for biopsy to figure out the diagnosis. However, after getting back from his procedure, our patient was looking far worse. His oxygen saturation was dropping to the 70’s, and he was going into respiratory failure. He was quickly transferred to the ICU, where the need for intubation was quickly becoming evident.
Our patient was terminally ill, and was about to suffer unnecessary measures to prolong his life. We tried contacting the patient’s conservator, a search that resulted in us dialing multiple numbers without luck. Meanwhile, supplies were being readied for intubation. Unable to get a response, we watched, defeated, as the patient was sedated and intubated. As a ventilator began pumping air into his lungs, the phone rang. It was the conservator. “Yes, you may make him DNR/DNI,” he said.
Not long after, the patient was extubated and placed on a morphine drip to decrease his pain and respiratory drive. He passed away shortly after. Yet, his last moments of life were likely full of confusion, agony, and fear. It didn’t have to be that way – if proper care had been provided for this man in the months before this hospitalization, the situation could have been largely avoided. Instead, we lost a patient on our service to unfortunate circumstances.