While rotating through the UCI this summer, I had a patient who implore me Water. He was intubated, so could not speak. Instead, he would scribble “chips” of ice in a notebook that kept us near her bed.
This patient had a feeding tube and an IV, so it was not malnourished or dehydrated in a medical sense, but could not give food or drink by mouth as if choking, he could have infected their lungs.
avoided him because he had a hard time meeting his eyes. As he gestured toward the notebook, I would say, “I know, I’m sorry,” and leave the room as soon as I could.
As fledgling psychiatrist , I try to recognize when and why I feel uncomfortable in my role as a doctor. Do not quench the thirst of this patient opened his eyes to how food and water are vital to feel alive – and how we as health care providers can do better to give our patients the quality of life when they are with us
When finally feeding tubes removed from the throat of the patient, the first thing he said was: “I have not eaten in weeks!” The senior doctor reminded the role of the feeding tube.
Doctors and patients are not always on the same page.
The language we use helps create this gap. It is much easier to make patients “NPO” which does not mean anything by mouth, which count on the fact that they are denying food and water. It is much easier to give people what they need to survive, rather than what they need to feel “good.”
Some of our elderly have diets or thickened liquid puree to prevent choking. I’ve tried. They are disgusting. Many patients feel the same.
A JAMA recent study , people with dementia thick liquids that were often turned away from them, with the risk of dehydration and other conditions. To better understand this diet and its ramifications, a group of health professionals at the University of California, San Francisco started thickened liquid provocateur , drink only this diet for a day. Their experiences, captured on video, are brutal in its honesty.
“Tastes mucosa,” said one young participant.
“It’s not so bad,” said a resident, as well as the face, pursed mouth and grimacing, he told a different story.
As a new doctor, these experiences have encouraged me to think carefully about how food affects the quality of life of my patient. While we can not always change the medical treatment of the problems of our patients, you may get to see when we can get lost.
During the summer, we had a patient who was rapidly declining. He was surviving on food pureed, while a chocolate bar Milky Way sat at a table beside him.
Our senior doctor told inmates serving this man that he is.
“You can finally eat the Milky Way,” said the doctor. “You must make your business before it leaves the ground.”