End of life

I've just finished my placement in geriatrics. As you can imagine, most of the these patients are 80yo+ and with quite end-stage of their conditions. I was treating this 89yo gentleman who has end-stage lung cancer. The doctors have told him that the prognosis is not good. The patient had planned to enter High-Level Care upto discharge from hospital and that is where he will be enjoying the rest of his life.

This gentleman was really nice . Friendly and approachable. I went to see him to ask him to walk so he could maintain his mobility and some muscle strength. He has severe SOB upto walking just 10m and desats to 82% on 4L oxygen. It was pretty bad.

On this particular day i went in to get him to walk and do his exercises. He says to me "Kenny, why should i bother continue doing it anymore?" I didn't really know what to say. Replied with the typical physio response "Maintain your mobility and muscle strength" i extended by saying "Even though you may not think it'll help, IF you ever stop walking, at least you can still have some muscle strength to assist nurses in transfers." My point was, even though his life was ending, he shouldn't be giving up, it will make a lot of difference for people who will be transferring you.

I've known this patient quite well during my prac. He has already planned where he is going after hospital and his funeral and his finances etc. He has told me that "i've enjoyed my life, Kenny" and i guess that's all you can ask for. So, to some extent i agree with him on why bother to continue walking/exercising. He is happy with his life and is happy to go. I think we can only do the best we can. If he chooses not to walk on that particular day, i won't push him.

I think it's important to be understanding of the patient. Think about life from their perspective. Physio treatment doesn't always have to be mobilising or exercising. By just talking to your patient can be treatment in itself. It'll only help to build rapport with the patient. My supervisor agrees.