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Don’t let any broken hip to go unfixed

Dec
28

Date: December 28th, 2013

28The story of a 94 year old woman with Alzheimer’s

At her old age of 94 years, she was suffering from advanced Alzheimer’s. She was thinking that it was in 1954 and she asked me if I wanted some tea. Well, that’s not really a bad memory considering that she was lying in the hospital bed healing her broken hip. She had fallen while at an assisted living facility and this wasn’t the first time as she had previously broken her collarbone. Within a year, she lost about 30 pounds and even though it is natural for someone with Alzheimer’s disease, it was quite upsetting for the family. This patient of mine was very luck and despite her old age, her children were very supportive.

Long ago, her son had the power of attorney over her health care and this officially meant that his decisions concerning her wellness and healthcare were legally binding. Due to her state, she was unable to make informed sound decisions, especially medical ones. The patient was being cared for by a geriatrician. According to the chart in his office, I knew that they had discussed the option of palliative care and hospice with her family. However, they wanted to learn more and the son was convinced that the ‘Do Not Resuscitate’ agreement was good for his mother. By 94 years, she was quite frail and no one would want to try chest compressions on her.

Offering guidance during times of critical illness

After being admitted with a broken hip, an intern at the hospital called me concerning the ethical dilemma she was in. The lady was DNR and the presence of intermittent VTach on monitor that she might not be sufficiently stable to withstand the repair of her hip. Such situations are usually the most trying times for any doctor. Most of them largely stress on minutiae rather than looking at the bigger picture. Guiding a patient and the family through times of critical illnesses like this one is truly a big service. The most important role that a patient should be concerned with is bearing witness.

After seeing the old woman lying comfortably on her hospital bed and being supported by her son and daughter, we started discussing about the concerned medical issues. This included weight loss, advanced dementia, multiple falls, anemia, hip fracture and potentially unstable and irregular heart rhythm. It was understandable that the objective was not to make the woman walk again but rather ease the pain and feeling. The son cleared stated that she needed no surgery and a consensus was reached with her doctor as well. They preferred hospice for her as this would enable her to live in comfort by not going through the indignity that further medication would bring her.

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