The hospital manager called me inquiring about the availability of a vacant bed in ICU to accept a patient from another hospital.
I told him that at that moment no vavcancy but I expected a bed to be vacant in few hours time as there was a terminal patient guessed to pass away shortly.
The story of that terminal patient was :
60 years old, end stage renal disease on regular dialysis for years, prostate cancer with metastasis everywhere, paraneoplastic syndrome.
He was admitted in the ward due to hemodynamic instability and progressive dyspnea ; managed palliatively.
Fully conscious.
He was begging for air.
I admitted him in ICU, put him on mechanical ventilation, just for the purpose of supressing the suffering of suffocation.
IV fluid was only sedation infusion 3 ml/h, 21% oxygen.
I expected him to pass away in few hours time as BP & O2 saturation were low.
Hours passed, yet alive.
Days passed, yet alive.
He passed away in day 12 of ICU stay.
Can a healthy indivisual survive a 12 days period deprived of food, fluids, and oxygen?!
We will continue to face unexplained cases beyond our expectation.
Similar cases teach us that we should think twice before talking about subjects related to:
"TIME ANTICIPATION"
in ICU.
I do agree with Dr. Mazen opinion. Such terminal patient should not be admitted and intubated. We are not the one who give timeline of death. Reference to Quran surah al Luqman-34 verse
إِنَّ ٱللَّهَ عِندَهُۥ عِلْمُ ٱلسَّاعَةِ وَيُنَزِّلُ ٱلْغَيْثَ وَيَعْلَمُ مَا فِى ٱلْأَرْحَامِ ۖ وَمَا تَدْرِى نَفْسٌۭ مَّاذَا تَكْسِبُ غَدًۭا ۖ وَمَا تَدْرِى نَفْسٌۢ بِأَىِّ أَرْضٍۢ تَمُوتُ ۚ إِنَّ ٱللَّهَ عَلِيمٌ خَبِيرٌۢ ٣٤
Indeed, Allah ˹alone˺ has the knowledge of the Hour. He sends down the rain,and knows what is in the wombs. No soul knows what it will earn for tomorrow, and no soul knows in what land it will die. Surely Allah is All-Knowing, All-Aware.
Hopefully you got the answer.
In addition for critical care admission, always follow the principles of ethics. One culomn of ethics is distributive justice. Do justice always irrespective of who is calling.
If you read the criteria of admission in critical care unit on priority basis, you can decline admission to critical care unit on following basis.
“1. The patient who are too well, should not be admitted to critical care unit as they can be easily managed in general ward.”
“2.The patient who are too sick and terminally ill, can not be benefited in admission to critical care unit. “
Jazak Allah khair.