About two weeks before my father passed away I was in the hospital with him while he was undergoing some treatment.
His file, or at least the most current one of his numerous thick files, lay on the table beside me. Since I had asked to see his file once before in the hospital, and been denied on the basis of personal privacy, I took advantage of this momentary lapse and put my best speed-reading skills to use.
I was pretty familiar with my father’s condition, both through discussion with his family physician and through my own research. He’d been treated well for a long period of time but just over a year before, during a visit to the emergency department, he’d been denied treatment (a platelet and red blood cell transfusion) and for all intents and purposes, was being left in the hospital to die. To get him out before that happened, I actually had to fly across the country and insist that he be released so that I could get him back under the care of his own physician who continued to be willing to offer treatment.
I knew what the issue was with the doctors in the emergency department and I wasn’t even in complete disagreement with them on a philosophical level, but when treated, my father responded well and so I wondered what they knew, that I didn’t, that might lead them to stop his treatment. A hasty flipping through the file gave me what I believe was the answer.
My father had a form of leukemia that caused immature white blood cells to reproduce wildly, limiting his ability to produce both red blood cells and platelets.
The lack of red blood cells made him weak and exhausted most of the time and the lack of platelets meant that he was covered in bruises from the slightest touches and a nose-bleed could kill him.
The transfusions he needed to stay alive gave him both red blood cells and platelets in a concentrated form. Undoubtedly, several blood donations were needed to refine the transfusions he required and in a system where blood supply was short, his age and compounding problems, without any other consideration, put him down the priority list of the doctors in the emergency department.
Unlike his own physician, they didn’t know him, didn’t understand he had 100 per cent of his mental capacities and, without too much bias, hadn’t gotten to know him and realize what a genuinely nice person he was.
His own physician, on the other hand, liked him very much and was determined to help him for as long as she could.
Still, I don’t believe this is the full picture of why the emergency doctors were making this decision. In the file was the result of an MRI done just a few months before this particular emergency visit that showed cancer all up and down his spine, all across his shoulders and extending into his skull. He was riddled with cancer.
He’d been treated for colon cancer and prostate cancer before but he had no idea that he had any problems other than the leukemia which, mercifully, had made him weak and tired but had given him no pain.
Looking at the MRI, I was completely taken aback and surprised that he did not have more pain than he was experiencing. I wondered then if the emergency doctors had really felt that his future might be full of pain and suffering and thus their decision not to treat him was done, in their mind, for his best interests.
I was left wondering, had they shown me this MRI more than a year before, if I would have told him about it, or if I would have made different decisions with regard to his treatment.
With the benefit of hindsight and good luck, the decision I had made was the right one for him and he’d had more than a year of pain-free, good quality living as a result. But it might well have gone the other way and he may have had a year of suffering that would have been difficult for him and our entire family.
In terms of best medical practices, the emergency doctors might have been correct in their decision and had I been given all of the information they had to consider, I might have agreed to their strategy.
When I put the file down, I couldn’t help but wonder what I would have said to him a year before if I’d seen his MRI. For a brief moment, I was grateful for my ignorance.
Graham Hookey writes about education, parenting and eldercare. ghookey@yahoo.com.
