The Doctor Will See You Now [Non-Fiction]

Chapter 115: General Medicine

Death is the end stage of all diseases.

There are often patients who personally refuse, or their families refuse, certain invasive procedures out of concern of the risk involved in said procedure and the decision that, even if it were something deadly (like an aneurysm -- dilated blood vessel that could pop -- or cancer), they wouldn't consider treatment anyway because the patient is too old or has too many other health problems that can't be fixed.

This is a reasonable decision. For the ninety-year-old frail woman who hasn't left her bed in her nursing home for years, who have a shadow on her lung, which is probably lung cancer, there isn't much benefit in giving her a bronchoscopy to snag a tissue sample to diagnose her with cancer, the treatment for which she is too frail to get anyway. It would just put her through a risky and uncomfortable procedure to achieve the same outcome: unfit for treatment.

Some people just don't want very invasive or heavy interventions, such as dialysis for the end-stage kidney failure, because it's hard work and comes with its risks (such as massive blood volume changes in haemodialysis, perforation of gut when inserting Tenkhoff catheters for peritoneal dialysis) just to prolong life for a few more months or years. This is also reasonable.

All of those diseases that are progressive will end inevitably in death, and possibly sooner in those cases because they declined intervention and treatment compared to if they had accepted. This is the consequence of deciding against investigation and intervention at an earlier time. And even though we always tell this to people who refuse intervention or treatment and they tell us they understand... we often see when it's time to face said consequence, they or their family do not accept it.

It's not reasonable that when the end actually comes as a result of those diseases left untreated -- and it comes entirely expected and as predicted -- then the family suddenly demands treatment.

The woman whose heart has stopped because her terminal lung cancer has reached the stage where her body cannot sustain life must now get CPR, her ribs broken and a tube shoved down her throat in an attempt to bring back a pulse -- but even if that pulse returns at the cost of internal haemorrhage and shattered ribs, her terminal lung cancer remains. She will then die a few hours or days later bleeding out internally, her chest caved in, and with a tube shoved down her throat making her unable to communicate.

The man whose end stage kidney failure has brought his life to an end, his family suddenly wants dialysis, the purpose for which is to prolong the remaining lifespan of the failing kidneys (which was why it was offered months or even years back). The remaining kidney lifespan is now exactly zilch. Because there is no remaining reserve left in a person who has died as a result of his kidneys having 100% failed. The golden window for which dialysis would prolong the remaining kidney lifespan has long passed.