Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
While a senior registrar in anaesthesia and intensive care in London
20 years ago, I gave an anaesthetic to a very elderly lady with an acute
abdomen. Laparotomy showed a widely ischaemic small and large bowel which
the surgeons felt was nonviable and nonsurvivable. By that time she was
showing signs of multiple organ failure and it was decided to palliate her
on a morphine infusion and send her back to a quiet part of the surgical
ward where her family could be with her. I wrote in her casenotes the
clinical findings and that she was going to die and that she should be
kept comfortable and not for further active measures.
While premedicating for the next day's list in the same ward 7 days
later, I noted the familiar face of a woman sitting up at the communal
table eating a light dinner. I didn't know how I knew her until I found
her name and casenotes. The last thing written in her notes from a week
ago was my entry that she was going to die and to be kept
Patients sometimes don't read the same textbooks us we doctors.
No competing interests
04 February 2006
S A Edlin
Staff specialist in Intensive Care Medicine
Royal Perth Hospital, Wellington St, Perth, Western Australia