Maintaining An Open Line Of Communication

Profound depression and even thoughts of suicide are common in people who are newly disabled after an injury or disease. It’s possible after viewing a series of images but generally not from a single scan. Many times, bleeding in the brain increases in the first hours after a patient has been injured. That’s certainly true if the individual has been given medication to prevent clotting but not so much with aspirin. With trauma, doctors might see very little bleeding on the first scan and a lot more on the second one. Our loved one always said, I’d rather be dead than disabled. How do we make decisions knowing what he said? Key considerations here are the extent of the disability and your loved one’s willingness or ability to adapt. Eventually, however, some individuals adapt to their new situation, rethink their attitudes toward the disability, and decide to try to make the most of their limited function. Sometimes, people become so driven by adversity that they achieve more than ever before. Human beings can adapt to almost any situation, finding satisfaction in the smaller things they can achieve and deriving happiness from their relationships with family and friends. Undoubtedly, however, some illnesses and impairments are extremely difficult for many individuals to endure. It’s the physician’s task to share the extent of the disability and explain in detail what living with it will mean.

Lay It Down

It’s not expected that most people will adapt to a state in which they are speechless, bedridden, fed by tubes, and have severe contractures of the limbs. However, some patients have displayed remarkable abilities to overcome and adapt to a major injury. Our loved one didn’t have an advance directive, and he never talked about his wishes. Many people never get around to preparing an advance directive or living will, or they’re reluctant to do so now. When a tragedy like that happens, the person’s family must somehow come to a firm decision about how their loved one would have dealt with the situation. It’s not always possible to know how someone might respond to a disability, but few people would want a life completely devoid of pleasure. I’ve seen some patients accept their new disability graciously, while others respond with frustration and anger. Individuals who are initially accepting may later become uncontrollable, unreasonable, and even abusive to themselves or others. Just because someone had a lovely personality doesn’t guarantee the person will retain it after a major brain injury. Even a formerly kind person can become mean and difficult, but the opposite never occurs. A common misconception is that a loved one can simply start over again and relearn what’s been lost. Rehabilitation is about learning to make adjustments.

The World Disappears

When family members are struggling to make decisions for a loved one who didn’t have a living will, I suggest that they think about how their loved one responded previously to major frustrations, hospitalizations or major health issues that caused significant limitations. Memories of those times may indicate which decision to make. I also recommend having lengthy, prolonged discussions with a physician. Such discussions almost always lead to a satisfactory resolution. I’m asked questions similar to this all of the time. It’s a question that harkens back to a time when physicians had or were given much more autonomy in making decisions about how to proceed with care. Family members should be reassured that they have the benefit of a physician’s seniority and experience as well as the physician’s personal opinion. What physicians would do for their own family members should never be different from what they would support for a patient. Which physician is responsible for our loved one, and who else is on the health care team? Families shouldn’t have to ask this question. They should be told right away who the attending physician is and who else is caring for their loved one and their roles. That significantly improves trust and understanding. I always tell families clearly who’s on the team.

Time To Move On

Families should also be made aware of how shifts work and when to expect staff changes. And it’s often easy to get one in the hospital. That’s because many physicians in a hospital will have already reviewed all or part of a patient’s case. For example, the neuroradiologist who reviewed a patient’s brain scans may have asked another neuroradiologist to review them as well. Family members may not be aware of such consultations. No physician with any scruples would balk at a family’s request for a second opinion. Is senior level, knowledgeable and experienced about the condition and has never taken care of the individual Has the skills to fully evaluate the patient independently and examines him or her under the best circumstances. Reaches a conclusion, discusses the findings with the attending physician, and resolves differences, if possible Acknowledges the possibility that there may be a different interpretation of the patient’s situation. Discusses the findings with family members and documents them. The problem with second opinions can be conformity bias. That is the desire to agree with the strongest, most convincing opinion and to trust the judgment of others rather than your own. What if I strongly disagree with someone on the health care team who’s taking care of my loved one? Caring for a loved one who’s comatose is stressful. Understandably, some family members have little patience left. Maintaining an open line of communication with your loved one’s doctor while also voicing and discussing your concerns remains key and often will restore trust. When trust between family and the health care team erodes, the relationship may turn sour. If that happens, a patient’s family members can always request that a different member of the team care for their loved one. Asking for a second opinion and transferring the patient to another hospital are both options if conflicts can’t be resolved. Negligence and even medical errors do occur, but they’re rarely a result of bad systems. Hospitals take issues involving patient safety very seriously.