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Answer & Explanation:. Introduction (25%) Provide a
brief synopsis of the meaning (not a description) of each Chapter and articles
you read, in your own words that will apply to the case study presented.
2. Your Critique (50%): Case Study
 My
Patient’s Dying
By
Molly Daughety, (4th year Medical Student), with Tarris Rosell, PhD, DMin
I had never seen it before. I had no
experience on which to base my unsettling suspicions. And yet, it was
unmistakable. My patient, Ms. P, was dying right in front of me.
I
later learned the tell-tale signs: labored breaths, blue-tinged skin,
disorientation—all of which this patient displayed. She drifted in and out of
consciousness, and had difficulty staying awake long enough to answer
questions.
“Do you have any headache or dizziness?
Any nausea or vomiting? “I shook her awake to repeat, “How’s your pain today?”
Ms. P responded, “My dear, your hands are so
cold.” She placed my hands between her own to warm them, then drifted back to
sleep. I woke her once more to ask if there was anything I could do for her. “I
just don’t want to be alone,” she replied.
That was the moment when I became aware of
what was happening. Ms. P was dying. She was passing from this life in front of
my eyes, doing so without family or friends to comfort and accompany. I sat
with her until she drifted back to sleep.
But then I left the patient’s room. There were
others to see. Rounds to join. Before moving down the hallway to rejoin the
oncology team, I stopped to ask a nurse for Ms P’s brother-in-law’s phone
number. I knew that he had been her only regular visitor during this hospitalization.
Then I called the number. When Mr. P answered, I told him who I was, and
inquired as to whether he was planning to stop by the hospital today.
“Yes,” he said, “I was planning to come after
lunch.” Mr. P paused, then asked, “Unless, you think I should come
sooner?”
I
did not want to worry him unnecessarily, and was afraid I had already
overstepped the bounds. Was it appropriate for a medical student to call a
patient’s family like this, even if she was

dying, on just my fifth day on the
wards?
“I’m not sure,” I said to Mr. P. “Your
sister-in-law just said she doesn’t want to be alone. So, as soon as you could
come . . . would be good,” I fumbled.
After
we hung up, I ran to join the rest of the oncology team for sit-down rounds. I
was late.Five minutes into that meeting, a
loud noise sounded in the hallway and the conference room telephone rang. As
the attending physician picked up the phone, his jaw dropped. He shot up from
the table and started speed walking down the hallway. Like well-trained recruits,
we all followed. The doctor entered a room with a blue light flashing above the
doorway. He shouted, “Stop! Stop everything. She’s DNAR.”
The code procedure stopped and the large code
team backed away from the bed revealing Ms. P, sprawled out on her back,
stripped naked but for the bright purple DNAR bracelet on her wrist. Her eyes
and mouth were frozen wide open.
What surprised me first was how different she
looked from the last time I’d seen her. Was it really just a few minutes ago
that she had said to me, “My dear, your hands are so cold”? Body and face were
mostly unchanged, but still Ms. P looked entirely different now without life
behind her eyes.
What struck me next was how terrible it was
that she died the way she did, exposed and vulnerable to the gaze of
twenty-plus spectators. The DNAR bracelet had also been exposed, in clear view.
How then had this happened? Why did no one, until the attending arrived, say,
“Stop!”?
I suddenly felt guilty, both about being there and then also about not having
been there. Being there now seemed like an intrusion on one of the most private
events of a person’s life, that moment of passage, of dying. I had not asked
nor earned permission to be present.
But worse yet, Ms. P had asked me to be there,
implicitly anyway. She had said, “I just don’t want to be alone”—which I
interpreted as not wanting to be left alone to die. Had I not left regardless?
Could I have done otherwise? Would it have mattered?
So
many questions. So much to learn.
CASE STUDY CHALLENGE