In 1957 I was a junior intern in the Vancouver General hospital. Myself and Gordon Warme were in charge of the medical ward called 1a, for staff patients in that month that had no other doctor. We were supervised by teaching consultants that came daily to observe our care. One was Dr. Boyce, a rheumatologist who was the Junior consultant and Russel Palmer, the senior consultant and notably aside , the originator of renal dialysis in North America.
I was on call for 1a in the early morning hours when an old woman was admitted from Emergency in extremis. She was in the late process of dying, her blood pressure was 60/0 and she had a large, fungating cancerous tumor, grossly infected, on the right side of her neck at least as large as her head. She was unresponsive and there were no next of kin listed.
These were the days of Levophed in the hospital. All patients that presented with blood pressures being unsustained, if not by blood loss, were required as a routine to be given a Levophed drip, monitored by the interns, to raise the pressure to acceptable limits. No conditions were usually excluded from this routine. Thankfully this madness didn't last beyond the next Medical executive meeting or so. I couldn"t bring myself to start a Levophed drip on this dying person with tremendous pathology and gave her adequate sedation instead.
When Dr. Boyce made early rounds that day he reamed me out in no uncertain terms for failing to treat the patient, as he termed it, not only for setting aside the hospital routine for unsustained maintanance of blood pressure, but for making an assumption that life or death was my decision to take. Accordingly I started a Levophed drip and monitored a miniscule blood pressure rise without any other change observed.
When Dr. Palmer made his rounds in the afternoon he said to me, " What madness are you doing here with this unfortunate woman who apparently still has no one to sensibly care for her." The message to me was clear. His opinion was my opinion. I took no solace from this because we were still in the uncertain state where individual decision making about treatment about each patient needed individual consideration rather than blanket ideas. Thankfully death took its course and her passage was serene and beyond our fruitless efforts and madness.
I was on call for 1a in the early morning hours when an old woman was admitted from Emergency in extremis. She was in the late process of dying, her blood pressure was 60/0 and she had a large, fungating cancerous tumor, grossly infected, on the right side of her neck at least as large as her head. She was unresponsive and there were no next of kin listed.
These were the days of Levophed in the hospital. All patients that presented with blood pressures being unsustained, if not by blood loss, were required as a routine to be given a Levophed drip, monitored by the interns, to raise the pressure to acceptable limits. No conditions were usually excluded from this routine. Thankfully this madness didn't last beyond the next Medical executive meeting or so. I couldn"t bring myself to start a Levophed drip on this dying person with tremendous pathology and gave her adequate sedation instead.
When Dr. Boyce made early rounds that day he reamed me out in no uncertain terms for failing to treat the patient, as he termed it, not only for setting aside the hospital routine for unsustained maintanance of blood pressure, but for making an assumption that life or death was my decision to take. Accordingly I started a Levophed drip and monitored a miniscule blood pressure rise without any other change observed.
When Dr. Palmer made his rounds in the afternoon he said to me, " What madness are you doing here with this unfortunate woman who apparently still has no one to sensibly care for her." The message to me was clear. His opinion was my opinion. I took no solace from this because we were still in the uncertain state where individual decision making about treatment about each patient needed individual consideration rather than blanket ideas. Thankfully death took its course and her passage was serene and beyond our fruitless efforts and madness.
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