You’ve Detailed Your Last Wishes, but Doctor’s May Not See Them

Dr. Daniela Lamas was working overnight when the familiar alert of her pager sounded. A patient had been admitted to the intensive care unit (I.C.U.). When she logged onto her computer to look at the elderly gentleman’s history, she noted a terminal cancer diagnosis, multiple surgeries and recurrences, and then a return home. That evening, the man had been found in his home, fevered, pale, and incoherent. The emergency room doctor treating the man reported to Lamas that there was “no family around. We’re probably going to have to intubate.” After hanging up the phone, one of Lamas’s residents tapped her gently but urgently on the shoulder, pointing at the computer screen. Hiding in plain sight was a note from the patient’s oncologist clearly indicating the man’s desire not to have chest compressions or breathing tubes.

This experience drove Lamas to delve into the world of electronic health records and advanced care planning. Through her research, Lamas consistently encountered tales of patients who were transferred to nursing care without their advance directives and later returned to the hospital intubated, when that was a course of treatment the patient had specifically declined. The current status of the medical field in regard to these directives is behind the times and desperately trying to catch up.

Fortunately for the elderly gentleman that served as the impetus for Lamas’s inquiries, when the resident reached the man’s room, he was relived to find that the man was breathing on this own. When he was eventually transferred to the I.C.U., physicians treated him with oxygen and antibiotics. Though he never recovered enough to return home, he was comfortable and quiet in the end, which is most likely how he would have wanted it.

See Daniela Lamas, M.D., You’ve Detailed Your Last Wishes, but Doctor’s May Not See Them, The New York Times, March 27, 2018.

Special thanks to Jessica Estrada for bringing this article to my attention. 

Special thanks to Lewis Saret (Attorney, Washington, D.C.) for bringing this article to my attention.