Unmanaged Expectations With End of Life.

Dear Dr Happy,

This note is later than I intended but i wanted to thank you for your great work with the Smith family. You really listened to them and took a lot of time with them and it made a big difference. Thank you, Care Management.

I received this letter in my home mail the other day. It's always nice to get complementary letters when so often I deal with demanding and irrational families with unmanaged expectations.

The Smith family is one of those families. Grandpa has advanced dementia. Grandpa is in his 80's. Grandpa can't make his own medical decisions. He is left to the whim of his family to do the right thing for him. Unfortunately, grandpa has a family with unmanaged expectations. 

After spending hours with this family over the course of my week of inpatient service with them, grandpa, in with multiorgan failure, got his procedures from head to toe, his feeding tube and a trip to the nursing home where he passed away a month later.

This family had unmanaged expectations. For no reason other than compassion,   grandpa should have been allowed to enter a hospice program with dignity.  They declined.  In the end these procedures did nothing for him.  They changed no outcome.  They made no difference.

My only success with Mr Smith was that I convinced the unmanaged expectations of his family to allow him to be DNR.

In retrospect, I think that is the greatest accomplishment of this 50K hospital stay. My hope is that grandpa died peacefully in his  sleep with before his family could have arrived and demanded transfer to the hospital to start it all over again.   We do a lot of stuff to patients because we can.