Day 342 Almost Euthanasized a patient Today !!!

It happened in the afternoon. The case manager on the floor called me and she told me under the phone if I could increase the morphine on a PCA drip that a patient who was in comfort measure (basically end of life care) I didn't really think about what she was asking me to do until it was too late. I wrote down the name of the room and went to visit the patient. An elderly gentleman about 80yrs old. Non-verbal and lying comfortably in one of the rooms on the general medical floor. I was surprised to see how relaxed and calm he was. I thought it was strange that she wanted me to increase the morphine. Anyways, I went over to the computer, and increased the morphine by 1mg on the pca pump. As I walked away to go to another floor. The nurse assigned to the patient came up to me and said "Can I talk to you." She seemed a bit upset. She then said "listen, I understand what you are doing. But I just wanted to tell you that I can't. And I'll tell you why." At this point she began to quietly cry. "I have a problem with this situation because I was the person who gave my husband the last does of morphine while he was dying. And I just can't do it anymore. I just can't.." She said the last words with difficulties as the tears ran down here face. Not even half way into the conversation I realized what I almost did. "I almost euthanasized this guy!!" I told myself in my mind. I told the nurse "I agree with you. And we will not go up on the pca dose." I'm gonna d/c the order and just put him back on his previous. Don't even touch it, leave it alone" I told her. She thanked me and walked away. As soon I walked the corner near the elevator, I looked behind me to make sure no one was behind me, and I "ran" to the nearest computer I could find to take off the order!

After all this, I took a step back to take a breath and went to the lounge. I couldn't believe what I almost did. I could have gotten in huge trouble. I can't believe I didn't realized why the case management was pushing for more morphine. The hospital has been flooded with full beds, and they are trying to discharge as much patients as they can. It seem like this guy was just in their way. I'm Glad an angel was looking at for me that day. I'm glad the nurse was smart enough to challenge the order. Glad I didn't break the Law !! Yet alone get kicked out of residency !!

Sometimes as an intern you make mistakes but some are harder to correct. The hardest of which is death!!!! I still remember running to my seniors in the unit when the patients were literally crashing before me!! I was scared out of my mind. Thank God for good team work.

God Bless

Dr.Mike