Monday, September 10, 2012

To CPR, or not to CPR?

Last Friday during Art of Medicine class.

The topic was "pain, death, and dying" under adult medicine. An interview was conducted in front of the class between our lecturer and a patient with acute myeloid leukemia. That's AML for short, and it's notorious for relapse, so our lecturer said. In other words, it will drain you of money and resources, and the life if you're not lucky. 

But the more interesting part came after. We were presented with a real-life situation that our lecturer experienced some years ago. From the outset, it seemed to demand an answer based solely on ethical standards as provided by those declarations (like Geneva, for example). 

But. hell. NO. Gray areas are what we have in real-life, not some yes-or-no that one can easily jot down on exam papers. So goes.

The matriarch of one of the richest families in the Philippines is dying of cancer. But she doesn't know it. In fact, it's only she in the entire money-making clan who doesn't have a clue about the cancer (inside her). The family, with whom you've been friends for ten years, had requested you not to tell her, and you'd willingly and understandingly obliged.

You are called in on Saturday afternoon because suddenly, she developed pneumonia. Everyone, including yourself, did not see this coming; truth be told, you all thought she was getting by quite fine. Now you have a very old lady with cancer + pneumonia. Not, not, not good. Before everyone's eyes, she's deteriorating - and very, very fast.

The problem is, she hasn't legally passed on everything she owns because she never knew she's dying. She's now fallen into a coma. A thumbprint can be acquired and that would be enough - but only if, by 12:00AM of Monday, she still hasn't been proclaimed dead. Not sure about the exact time, but you get the gist. Why Monday? Because government offices are closed during weekends a.k.a. if she dies anytime during the weekend, the thumbprint, and in turn, the papers will be considered null and void because they were processed while government office was closed. Apparently, processed papers will only be considered legal if they are done while the person in question is still 'alive'.

What happens when everything she owns doesn't get legally transferred to her children? Inheritance Tax. More than half of her estate (so the lecturer said) goes to the government. The immensely, screwed-up Philippine f*cking government. And we're talking riches the scale of Henry Sy or Ayala. While she lived, she never wanted a single cent or acre of land to go to the govenrment. And all of you very well knows that even in death, she'd make sure nothing, not a single drop from her entire life's hard work, goes to the government.

So, keep her alive. By alive, we mean not legally proclaimed dead. And because doing a CPR on an arresting person means not proclaiming death, here's what the family asks you to do: If she goes into arrest anytime during the weekend (which you very well know she most likely will), four burly men will take turns doing CPR on her for as long as the weekend is not over. That means if she dies in the early hours of Sunday morning, you're looking at 16, 18 hours of nonstop CPR. On a body that's very well lifeless.

The question was phrased this way: 16 hours of CPR on a dead body, or no 16-hour CPR?   

It was a question that divided an entire class, 55-45(%). Even our lecturer admitted to never fully knowing whether or not he ever made the right decision.







Anyway, what happened was this: She arrested at around 4AM Sunday morning, and a 30-minute CPR was done to no avail. And yet, everything she once owned was successfully passed on to the heirs. The Inheritance Tax never came round in time, care of a couple of senators and some friends in government. 

As expected from this country.

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