Hi, I'm Rob Fowler, I'm a Critical Care and General Internal
Medicine Physician at Sunnybrook Hospital, and over the next few minutes
it will be my pleasure to walk through our policy at Sunnybrook Hospital that tries to help
provide best care for patients, especially at
the end of life. We've had a lot of work on end of life and trying
to improve our ability to deliver the best care for patients that
are at that very tough point in their life, for many years.
And it's come together as a policy among the physicians and
nurses, spiritual leaders and allied healthcare team over
the last few years. At the end of life, having an appropriate
care plan and one that respects their wishes and also respects the
limitations of some of the treatements that we can provide
is really important. We try to base all of our treatment
decisions upon what the patient, and if they're not able to
communicate with us directly, their family members or their substitute decision makers
are able to tell us about what they wanted through their life and what they might want
in times like this. Our job is to try and help
the families understand what the medical system
and nurses and doctors are able to do to help patients ideally get
better, ideally get them to a point where they are out of the hospital and
feel better, but sometimes it's not the case that we're able to
cure. It's important for us to balance the aggressiveness
that we are able to technically provide, especially in the intensive care unit,
with a focus on making sure the patient
is comfortable, making sure they are not suffering with
pain or anxiety that sometimes accompanies severe illness
and that we are able to try and keep patients comfortable
even if we can't cure them.
The ventilator,
medications intervenously, dialysis machines and other things
can keep the organs working for a long time,
often though, we have a hard time getting the whole body better and
it's important for us to try to help both patients and families
to understand when we are at the limits of our ability to get
people better and are unfortunately in a position where we may only be
supporting their organs, and really not them as a whole person.
And maybe not able to get them back to a quality of life and state of life
that they had hoped for.
When patients are inside the hospital and
are admitted for an illness, the chances of CPR
being effective in getting them to a point where we are able to reverse
something imminently reversible, unfortunately diminish quite a bit.
And I think a lot of us are very much influenced by
what we maybe see through television programs where CPR is
being used very frequently inside the hospital setting and the emergency
room on hospital wards for patients that are quite sick and
it's interesting that on television shows it's almost
uniformally effective and patients frequently leave the hospital
smiling and doing very well. In real life, inside the
hospital, CPR when someone is very ill to begin with
is often less effective. The notion that CPR will
always revive someone unfortunately just isn't accurate.
And in the process of doing chest compressions and shocks to the heart
the patients that were minimally conscious or regain
consciousness for a period of time after that event, it can be a very
uncomfortable procedure and often leads them to a
condition that was much worse than they were in to begin with. At some point
we're all going to go through this period that leads us to
the end of life and one of the goals we might have here
whether it's for a young person, for an older person or someone
who was previously healthy or someone that has in fact suffered for a long
time with a certain medical condition, is to try to get through that
phase of life, at the end of life, as comfortably as possible,
applying medical therapies and technologies as much as
we can to try to reverse things that we can reverse
to try to help familiies and patients through that phase where maybe they are
not any more medical therapies that will cure them but maybe there
are treatments that we can apply that will help keep them comfortable
and help provide as good an attempt at
a good death as we can.