Invasive procedures

BMJ 2005; 331 doi: (Published 15 December 2005) Cite this as: BMJ 2005;331:1461
  1. Victoria Thomas, foundation year 2 doctor (v.e.thomas{at}
  1. University Hospital of Hartlepool, Newcastle upon Tyne

    Another busy night shift as a medical house officer. At about 2 am my bleep shrills, and I call the number with a resigned sigh. I'm told about a sick patient in the high dependency unit, an elderly man who had coronary artery bypass grafting to treat his ischaemic heart disease 18 years ago. He has known heart failure, peripheral vascular disease, sepsis, and renal failure. No resuscitation decision made as yet. Just another call about just another sick patient with a dismal prognosis.

    But, of course, it wasn't. The call was to my mother in a hospital in another city, and the sick patient was her brother. I wasn't asked to do anything, just to explain what was going on to my own family, who were too intimidated to ask the doctors on the ward. I listened in silence as my mother described the family bewildered and baffled: no one had told them how sick my uncle was until he was taken to the high dependency unit, and no one had discussed resuscitation with them until now, when the staff were struggling to put in a central line.

    “They've asked us whether we want them to perform any more invasive procedures,” my mother said. “I'm not sure what they mean by ‘invasive procedures,’ but, reading between the lines, we think ‘invasive procedures’ means things that hurt, and we don't want him to be in pain any more. Are we right?”

    Invasive procedures means things that hurt. Yes, I supposed she was right. We talked for a while about how she could talk to the medical staff in the hospital, and to the rest of the family, about what was to be done. We both cried a little. And I returned to my shift feeling thoughtful.

    My uncle died a few days later, having had no further invasive procedures and with his family around him. And I try not to use terms like “invasive procedures” to families any more. Not all of them have a junior doctor on hand to translate when they're too afraid of how busy we are and what the answer might be to ask us what we actually mean.


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