Monday, December 19, 2011

A fundamental question - Is the treatment giving a better quality of life?

I had written about dialysing our elderly here a few days back. I reflected on that deeply a few days back while discussing the treatment options of a patient with her son along with a nephrologist. The lady was 70+ years old. Her son was as committed as ever. I could tell that the option for withdrawing treatment had not once crossed his mind.

The nephrologist made a very important point. The question she asked was, "Is the treatment doing anything to improve her quality of life or is it merely prolonging her suffering?"

It was easy to see that the dialysis session was nothing short of torture for the patient. Within a few minutes of starting, she would ask for it be closed. She was also not totally aware of what was happening around her. For her, it was a strange surrounding even though she had been there a few times. In her mind she was probably wondering why she had been brought there.

The family was considering PD as one of the options to make it easy on her. The nephrologist did not feel it would benefit her.

The nephrologist asked the family to consider this question and answer honestly if they really thought the treatment was benefitting her.

Once the conversation wound up, the son went over to her mother and gently stroked her head asking her if she wanted to eat anything. He could hardly hold back his emotions. Neither could any of us.

7 comments:

madhava said...

yes, Kamal, after all these years of HD one of the most troubling experience i undergo nowadays is not only the difficulty of hd, but seeing people (like you have mentioned on your post) undergoing this. i always feel that ladies should not at all get this, i am not saying men can get it. but seeing elderly ladies undergoing hd troubles me a lot. i feel like i just want to quit everything.

suman sharma said...

hi kamal, i was also ignorant a few months back about plight of kidney patients. My father,67 years old was diagnosed wih CKD advanced in the month of july this year. I brought my parents here with me in delhi. Right now he is on allopathic medication , once a week ethyropetin injection and baba ramdev medicines.Six months have passed ,thankfully his condition has not been deteriorated much. But i also think what will hapeen to him in next six months or one year. I got scared thinking that one day doctor will be prescribe him dialysis. I dont think that i will be able to afford it too long for him. Moreover i cant see him going through the procedure. But what can i do at that moment in my life except feeling helpless. Information given on your blogs really help us and gives moral support to go through it. i wish you all the best for your life. May god bless you.

Kamal D Shah said...

Hi Suman, thanks for your comment and sorry to know about your father. Let's hope he never will reach the stage where he has to undergo dialysis.

suman sharma said...

thanks kamal for such a positive remark on my father's condition.
You are a young man and i think weekends ahead will be party time for you. Enjoy your life.Merry Christmas and happy new year in advance.

Anonymous said...

on the other hand, what really irritates me is when I see relatives who think they know whats better for the patient than the patient herself - it has to be the patient's call about accepting or rejecting a medical procedure - especially when she still has the ability to do so. A lady in her late 60's with full medical insurance from her employer was admitted to Apollo JBH next to my dad's bed. She was on a ventilator but soon came out of it and she did not definitely look frail or weak. She was responsive to her folks, was nodding answers and smiling back. However, her son-in-law - a lawyer by profession, convinced her husband that she was in great suffering and that there was no point leaving her admitted in the ICU. When this old man shared his story and his sadness at his inability to help his wife, I asked him if the doctors recommended she be discharged because there was nothing they could do. I also asked if his wife wanted to be taken home as she seemed quite responsive. the answer was negative for both questions but by next morning, she was discharged. I only hope she is much better off now but am disappointed at the way decisions were made on her behalf. It is probably time for folks in India to start thinking about executing something equivalent to US's "Advanced Directive" as a part of their will.

-Santosh

Ab said...

The world has come to a stop for me. Today my mother who is 70 and a diabetic for the last 16 years has been advised to under go dialysis...the news came as a shock for me and I am feeling helpless since then. My mother has said she will not undergo dialysis but the doctor says that she is in stage 5 of renal failure and dialysis is the only option. I am not sure if she will be able to take this...i am at a complete loss, I cannot decide what to do....

Kamal D Shah said...

Ab, I am really sorry to know about your mother. Please send me your email address and we can talk. My email is kamal@kamaldshah.com.