Chapter 1476: Advance Directives?

Chapter 1476: Chapter 1476: Advance Directives?

(Thanks to DRDER for the monthly ticket encouragement)

"Nuonuo, how is the patient’s condition from yesterday? What was the final surgical decision?"

The next day at work, Liu Banxia asked.

Although the patient yesterday wasn’t particularly special, she was representative of the current situation faced by middle- to low-income groups encountering serious illnesses.

Some might say, who doesn’t have tens of thousands in savings?

It’s hard to say, especially for families who have just taken loans to buy new houses—it can be tough to come up with that money.

"Teacher Liu, we did another MRI yesterday, and it was clearer. Director Xiao thinks the tumor is too large and the infection is quite severe, necessitating a craniotomy," Xu Yino said.

"However, craniotomy is more expensive. The family wonders if it could be removed via the transnasal approach. Plus, the patient’s condition is complicated, requiring ICU observation post-surgery."

"Director Xiao didn’t provide a response immediately because the tumor’s size poses significant challenges for a transnasal approach, making it difficult to ensure complete removal."

"Oh... it’s an unavoidable situation," Liu Banxia sighed.

This isn’t just a matter of tens of thousands.

Even with insurance covering some costs, the family must carefully consider their options.

But it’s not something he needs to worry about now; the neurosurgery department will handle related matters.

If he gets too involved, it’ll just complicate things.

Leading the trainee group on rounds, the current ward patients are stable. While there are new arrivals, some are scheduled for elective surgeries, others have minor issues.

Post-operative patients are recovering well, bringing Liu Banxia a sense of relief.

Post-operative infection is a common issue, but he’s been fortunate so far. Even when patients experience fever symptoms, they’ve been quickly controlled, with no major problems.

Reviewing cases transferred over from Zhou Shuwen, he takes a closer look at the records. Though routine surgeries, each patient’s condition is unique, requiring specific analysis.

As he examines the records, Wang Zhaoping, an internal medicine intern, enters.

"Director Liu, Teacher Xu just admitted a patient and encountered a situation," Wang Zhaoping said.

"The patient was brought in by his eldest son and has a history of Alzheimer’s disease. He collapsed at home, and examination revealed bilateral dry rales in the lungs and pitting edema in the legs."

"Teacher Xu suspects acute renal failure and has ordered related tests. The issue arose when the second son and daughter arrived, claiming that if a life-threatening condition occurs, the patient should be let go."

"This was a preliminary statement given by the patient when conscious, but the second son and daughter don’t acknowledge it. Despite no results yet, they’re in a heated argument."

"Teacher Xu temporarily separated them and asked me to inform you, seeking your advice as this is a first-time encounter with such a situation."

"This is quite tricky. How old is the patient?" Liu Banxia frowned and asked.

"Seventy-one years old," Wang Zhaoping replied.

"Oh... I should go and take a look. As doctors, we really don’t have any stance on this," Liu Banxia said with a wry smile.

Decisions regarding whether or not to resuscitate a patient often have blurred lines.

The fundamental issue is the unclear definition of rights between the patient and family.

Some patients with terminal cancer prefer to follow family views, opting for conservative treatment to reduce pain rather than invasive resuscitation.

Personally, Liu Banxia agrees with this approach.

Because the result of resuscitation often means money spent, suffering endured, with no outcome.

However, some patients encounter unexpected situations where different levels of resuscitation might offer hope.

But making such decisions is tough, as full treatment can involve expensive drugs and significant costs, with risks of rescuing still failing.

And this decision, when the patient is unconscious, falls to the family, often leading to disputes.

Today’s situation? It’s particularly unique.

Because as per the eldest son’s account, there was a preliminary directive.

If it’s truly acute renal failure, then it’s a potentially life-threatening condition, eligible to trigger the directive.

However, there’s an unclear aspect:

The patient has Alzheimer’s disease—does this directive still hold?

There’s another possibility, a rather malicious one: Did the patient actually give such a preemptive directive?

This might be what the second son and daughter are focused on, but judging from the current situation, it’s clear that this family is not very harmonious.

Normally, if an elderly person makes such a preemptive directive, they would surely call all their children around them.

As he walked down, he saw a small group of people gathered at the internal medicine clinic door, discussing something. They were all quite emotional; it seems these are the patient’s family members.

"Brother Xu, having trouble, huh?" Liu Banxia said as he entered the clinic.

"Ugh... it’s very frustrating. Now the patient has regained consciousness, but his thoughts are somewhat confused, making normal communication difficult," Xu Hui sighed.

"I’ve never experienced something like this before, so tell me, what exactly should we do? Judging by the patient’s condition, it seems to have reached the uremia stage."

"I’ve never been through anything like this either. I haven’t been in the field for long. What are your thoughts?" Liu Banxia asked.

"I don’t have any particular thoughts, but I tend to believe the patient discussed the preemptive directive with his eldest son," Xu Hui said.

"I overheard some argument, and it sounds like most of the family inheritance was left to the eldest son, who is also responsible for elder care and funeral arrangements. The patience with the second son and daughter isn’t very close, making me quite frustrated, so I let them go discuss it outside."

"Hypothetically, if the patient is diagnosed with uremia and requires dialysis, and the family disagrees, what should we do?"

"Normally, isn’t there nothing we can do?" Liu Banxia asked.

Xu Hui nodded, "The patient’s consciousness isn’t clear, and considering he also has Alzheimer’s, we can only respect the family’s opinion."

"At most we can give them time to discuss, but looking at the current situation, it’s unlikely they’ll reach a conclusion. Whether or not to resuscitate, they must agree first."

"That’s essentially what I think too. After all, the eldest son mentioned the preemptive directive, and we can’t just disregard that," Liu Banxia said.

With his words, Xu Hui now has a direction.

In this scenario, Liu Banxia, as the deputy director, holds some authority.

It’s not that Xu Hui is looking for Liu Banxia to take the blame; such situations must be reported to senior leadership. Otherwise, it might lead to big problems.

"Teacher Xu, the patient’s results are back."

Wang Zhaoping rushed in and handed the test results to Xu Hui.

Xu Hui glanced at them and passed them to Liu Banxia.

"Oh boy, according to these indicators, he’s already teetering on the edge of uremia. If tested again now, it’d likely confirm uremia."

After reviewing, Liu Banxia furrowed his brows.

"Given the current situation, I can only insert a catheter and adjust electrolytes," Xu Hui said.

"Alright, I’ll bring the family to the conference room to see what their thoughts are on this matter," Liu Banxia nodded.

This kind of treatment is conservative and won’t conflict with the possible preemptive directive from the patient. Given the eldest son’s mention of life-threatening diseases, this condition is currently just borderline.

"The test results are in. I’ll provide catheter insertion and electrolyte adjustment treatment," Xu Hui said outside.

"This is our emergency center’s Director Liu; soon you’ll all join him. Then discuss and formulate a plan, as we still have to heed your decisions."

"Doctor, we must save my dad, no matter the cost," the patient’s second son spoke.

"It’s not about money now; the patient is showing early symptoms of uremia. Dialysis can relieve, but the cure is a kidney transplant," Liu Banxia said.

"Considering the patient’s age, medical history, and current physical condition, the outcome of a transplant wouldn’t be very promising. So let’s have a discussion first, Wang Zhaoping, guide them to the conference room."

"Please follow me; arguing here will affect other patients’ consultations. We’ll provide conservative treatment to the patient," Wang Zhaoping said.

The group exchanged looks before following Wang Zhaoping to the conference room.

"Banxia, keep it up, make a quick decision," Xu Hui whispered.

"Got it, the patient’s health indicators are poor. If we don’t do dialysis soon, things could get worse. Delaying decisions might mean dialysis isn’t an option," Liu Banxia nodded.

He had just reviewed the patient’s test results and found them quite concerning.

At seventy-one years of age, maintaining daily exercise might keep the body in better shape. Accompanied by Alzheimer’s, his physical functions have significantly declined.

That’s why he planned to take these people to the conference room, to avoid regrets from any of them later.

Here, today is just the beginning; even if they argue for two or three days, it’ll only deepen conflicts, with no other benefit.