Avoidance

For all of you who know me you know I have an interest and passion for end of life/palliative care. It is something I feel very strongly about and work hard to make sure my patients and families are comfortable at the end of life.


Due to my interest in end of life care I have had many frustration on the wards. I have discovered that as a patient dies here very little attention is given to the patient. There is one patient on our team who was admitted last Monday with altered mental status. He quickly declined and now is completely unresponsive, has bed sores from being unable to move, and started having seizures. On Wed, Thurs, and Fri of last week I was the only person to see this patient. The rest of the team skipped over him during rounds despite my reminding them. This patient is still alive, which is truly amazing, and recieves very little attention if any at all. Nothing is being done to make him comfortable.


A similar situation occured last week. We had a patient that presented with an intestinal obstruction and was found to have a large mass in his abdomen. We were planning on doing a CT scan of his abdomen but he quickly went downhill, we were not sure why. On our morning rounds the patient had agonal respirations (a sign of immiment death) and there was nothing else for us to do. The attending physican (head doctor) and I had the following conversation....


"Dr. Lupov, do you think there is anything else we can do for this patient?" Attending


"No. I think our focus should be to keep him comfortable." Me


"I agree. Our plan should be to keep him comfortable." Attending. After saying this he walks away and moves on to the next patient.


"Wait...do you have IV Morphine or Ativan? What can we give this patient to make him comfortable? He clearly looks like he is in pain and has a lot of air hunger." Me


"Giving those drugs is euthanasia and that is illegal in Kenya." Attending


"I disagree. We can keep patients comfortable without expediating there death." Me


"If you give that man Morphine and he dies, the family will say you killed him." Attending. At this point he stopped talking to me and moved on to the next patient.


How incredibly frustrating and sad. It has been so hard for me to watch numerous people on the wards die with absolutley no effort to keep them comfortable. I have not given morphine to a single patient since I have been here (and I have seen a lot of people die).


After talk about this with several people I have calmed down a little (not all the way) and realized that the Kenyan doctors' attitudes is likely a defense mechanism. Due to limited resources there is little to nothing to do for these patients. It is easier to avoid the patient then face the reality that the patient is dying and there is nothing you can do.


I hope palliative care/hospice can take hold here in Kenyan and change this attitude. Every person deserves dignity at the end of life and I believe it the physicans duty to make sure that happens. It has been hard to me to keep my mouth shut, because I don't think it is something I can change now. It will take time and many people to implement this changes. Maybe I can be a part of it in the future.