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As I was filing out the form I couldn't help but discuss the terribly sad story of one of my other patients with the critical care nurse and burst into tears. I was surprised by my own reaction - perhaps its because I am the sort of person that likes to discuss things with others but often feel like my seniors are not interested or have no time - so when I did get a chance with the nurse it was very emotional. I cried about a patient who had just come in 3 weeks previously; a very socially active and intelligent elderly lady with presumably treated bowel cancer (surgical removal and liver ablation to liver mets but no sign of other mets on a recent CT) who was bleeding and we didn't know why. My consultant had just told her that very day that we were to give her a couple more units and that was all (a DNR form was filled out one week previously). She agreed to the further couple of units but how could anyone looking so sick, pale and frail make such a decision? It deeply distressed me that my consultant had made the DNR form and decided on only 2 more units of blood. I was too busy and frankly didn't even have time to think about my emotions to query my consultants decision at the time he made it, but later spend two days feeling miserable about it.
I felt like as a doctor I should be saving people, and although I accept death I do not accept passive euthanasia. I feel like I am lacking in information, but overly charged with emotion. I feel like I need to talk to my seniors regarding possible other avenues we could have used for her - I have to trust in their experience over mine and I can't talk to them as I feel it will be too controversial. I guess all I can do is hope that my understanding of why it is necessary to cross off medications when a patient is put on the LCP is necessary, and why we decided to talk such action on the second patient will come with time.
I am blogging this as I would like someone to shed some light onto my situation as I don't know whether or not I am mistaken in my thoughts, and would like to know if anyone else is in/has been in a similar position to me.
Also, I have tried to research when it is that DNAR forms would need to be considered, and have failed to find clear-cut guidelines on this. If anyone reading this can give me some guidance on where to find this, or has knowledge on this, it would be much appreciated.
Many thanks for your time in reading this,