Filler

We should not play God

It was shortly before Christmas. Richard was 38 years old and had inoperable non-small cell lung cancer. Chemoradiotherapy had held the disease at bay for a while, but at the expense of his renal function. Two weeks earlier, he had been told that no further treatment was possible and to prepare for the worst. Dialysis was not an option, so there was no point in seeking a renal opinion. He had been discharged from the tertiary unit for palliative care.

The call came at 10 pm from the local chest physician. Richard was breathless, oligoanuric, and in extremis. A week earlier he had been at work holding down a high powered job. Abdominal pain meant that he was taking a high dose of morphine, but his quality of life remained good. His three young children and his wife were distraught. Things had happened too quickly. They were not prepared. He didn't want to die. Could anything be done?

It is rare to consider a patient with such advanced disease for dialysis, but something struck a chord. Perhaps it was because we were the same age. Perhaps it was the family. What would I want in his position? Who was I to deny treatment when he might just benefit? He was transferred to the dialysis centre, and we spent a long night stabilising him. Several times he nearly died, and I wondered if we were doing the right thing. Colleagues were sceptical, his oncologists incredulous. And yet, three days later, Richard left hospital, off all opiates and feeling better than at any time in the previous six months.

Over the next four months, I came to know Richard well. He knew that we had bought him only a little time, but he used that time. He never complained about dialysis, arguing that the months gained were beyond price, beyond inconvenience. He celebrated Christmas and the new millennium with his family, saw his youngest son's sixth birthday, and made his arrangements. He died in his sleep, at home, with his wife at his side.

Many months have passed, but I think of Richard often. Looking after him was an emotionally draining experience, but one of the most satisfying of my career. Above all, I believe that we did the right thing, and that we should not discriminate against people on the basis of their diagnosis or their expected prognosis. We do not have the right to judge quality of life. All we can do is offer information, advice, and, if asked, an opinion. We should not play God.

Peter A Andrews, consultant nephrologist. 

Surrey (pa.andrews{at}btinternet.com)

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