Not Treated Like a Dog

I saw an old patient of mine in the emergency room a few weeks back. He had broken his hip and was happy to see me because I had replaced his knees quite a few years earlier. In his mid eighties, he was living at home with his meticulously groomed and well-coiffed attractive wife of 60+ years.

There were options for this gentleman. I could do a quick and easy repair that would necessitate his not walking on the hip for a couple of months, or I could replace it, give him a new hip and get him going. He was a busy man, he assured me, with a garden to tend and a yard to maintain-- he wanted to get home and get back to business. So, a hip replacement it was.

One of the problems with taking care of an elderly person is that you don't always know when what they want to do is no longer what they can do. Needless to say, my patient needed to go to a nursing home for rehab for a few weeks after surgery.

Three weeks later he was back in the hospital with pneumonia (a "readmission within 30 days," an event for which Medicare no longer reimburses hospitals). And that's when the nurse noticed his wound was a little red.

My patient went on to require 2 more surgeries to wash out his infected wound. He had pneumonia, miserable pain, hated going back to the nursing home, and pleaded with his doctors, including me, to just let him die-- the latter something he managed to do on his own about 8 weeks after the whole miserable episode started.

I feel confident there was nothing technically wrong with the care he received. We followed all the "best practices," we met all the "core quality measures" set by the Centers for Medicare and Medicaid Services. But, in the end, I think our system failed to take care of a frightened old man who was in pain and dying. He had hospice care but not until the bitter end.

I've been thinking a lot about this man and his wife the last few days since I learned of his passing. And it leads me to think about this: If we euthanize our dogs when they are suffering and dying as an act of human kindness, why do our elderly have to suffer and beg?