Monday, November 30, 2009

Three Rivers and Prognostication Sunglasses(?)

I'm always on the look out for palliative care topics in the movies and on television. Last week I happened to see two different television shows that I found blog worthy.

The first was an episode of Three Rivers entitled "The Luckiest Man". (The full episode is available online (legally) for a short time through the above link.) Not a program I usually watch as I generally am not a fan of medical dramas. This episode centered around Victor, a man with ALS who was in a car accident. He was already quite debilitated from the ALS. The injuries he sustained in the accident left him ventilator dependent and with no real hope to regain his previous independence. Enter a gentleman with severe lung disease and another with severe heart disease (on an LVAD as bridge to transplant).

At first, Victor is given two options, fight or die. He chooses to fight. His condition worsens and he makes a different decision. He wants to be removed from life support so that he can donate his organs. He makes a great point when he says he was only given two options but he sees a third. He wants to take back the control over his destiny that he feels he lost with his ALS. This leads to ethical dilemmas amongst the medical staff, especially the surgeon caring for Victor. Victor's plan was also complicated by his daughter who disagreed with his decision and blocked it for a short time on the grounds that she was his DPOA.

As with all medical shows, there was some inaccuracy. I'm pretty sure that you can't just choose who gets what organs. There didn't seem to be a great understanding of the whole Donation After Cardiac Death process (what can and can't be donated). Also, some confusion about the power of a DPOA. And television always screws up ventilators. All inaccuracies aside, there was some intriguing dialogue that took place.

Some of the issues that were brought up included:Is choosing to withdrawal life support suicide? What is a good death? What is quality of life? And who defines this, the doctor or the patient?

One of my favorite lines came from Victor "There's a difference between committing suicide and choosing to die with whatever dignity I have left." I found that this show often hit the nail on the head when it came to the ethical issues.

The second interesting palliative care related program I watched was an episode of Medium entitled "The Future's so Bright". (Another legally available online program, for a while.) For those unaware, Medium centers around Allison, a woman who has dreams about how people died then assists police in the capture of their murderers. In this episode, Allison develops a strange intolerance to light. She finds a pair of sunglasses to wear which turn out to be from a murdered man she has been dreaming about. When she puts them on, she begins to see strange numbers on people's foreheads which she later discovers are how many days they have left to live. (I know. Very far out there.)

My first thought, "Wow, what a useful prognostication tool to have!" Should we discharge Mr. X home with hospice? Hmm, let me put on my sunglasses. 60. Yes that would be an appropriate plan. How long will she live after we take her off the ventilator? Hmm, looks like 1 day. No need to discuss discharge options.

Ok, I know there would be a down side. Try to resist the urge to look in the mirror. I wouldn't want to look but... How do you avoid looking at your spouse's or your children's numbers? If you see a friend is going to die in two days, do you try to intervene? Maybe the intervention is what gets her killed. These were all issues explored in the show. Funny, they really didn't explore the palliative care potential.

5 Responses to “Three Rivers and Prognostication Sunglasses(?)”

Dr. Pam said...
November 30, 2009 at 5:41 PM

LOVE Mandy Patinkin--thought he did a good job with the role on "Three Rivers". Actually, if you go outside the UNOS system, I believe you could direct donate organs as it would be similar to donating a kidney to a relative. (This was just a lot bigger, and unusual, donation.)


Amber Wollesen, MD said...
November 30, 2009 at 7:54 PM

I agree, Mandy Patinkin did a great job. I've been a fan since 1987 (The Princess Bride).

So a person can just decide who they want to have which organs? Have you heard of such cases? Probably doesn't come up a lot.


LeighSW said...
December 10, 2009 at 6:48 PM

I had never watched Three Rivers before but did happen catch that episode. I was so irritated by the DPOA inaccuracies and HIPAA violations (patients and families just showing up in his room to ask for an organ? Please!) that I haven't watched the show since but I agree that the episode did raise some interesting questions.


Amber Wollesen, MD said...
December 11, 2009 at 1:07 PM

I agree LeighSW. The people lining up to ask for organs was disturbing and unrealistic. And the end when he was fully awake and going in to the OR with all the families sending him off, also disturbing. Probably meant to seem uplifting. I thought it was just weird.

Thanks for your comment.


LeighSW said...
March 16, 2011 at 11:54 PM

I had never watched Three Rivers before but did happen catch that episode. I was so irritated by the DPOA inaccuracies and HIPAA violations (patients and families just showing up in his room to ask for an organ? Please!) that I haven't watched the show since but I agree that the episode did raise some interesting questions.