Monday, November 23, 2009

Fork in the Road

I scurried down the hall of the intensive care unit to write down verbatim what he had stated so powerfully, so exquisitely. His words resonated deeply with me, defining the challenges we so often face when caring for the sickest patients.

"We're coming to a fork in the road and we plan to take it but we don't know which one it is."

This past weekend I was "on call", making hospital rounds for the kidney service, writing notes, and coordinating care plans with colleagues. One patient was extremely ill, admitted in the middle of the night with a septic syndrome, renal failure, and myriad other complications. This (unfortunately) is not unusual. The critical care doctor in charge of his management is excellent; someone for whom I have the highest regard. We had a several minute conversation regarding this patient, acknowledging the ambiguities of his care, the decisions that required attention in the setting of "no good options", and the need for a thoughtful "time out" before choosing the path.

How different is real-life medicine from glamorized television shows such as E.R. or Grey's Anatomy where there's seemingly only one choice, the "right way" and the "wrong way" with doctors making crucial decisions in seconds, suddenly knowing exactly what must be done? Not so.

I agree with my colleague; there are many times when there is a fork in the road. We will take "it" because the time will come when we must decide, but right now in this moment we don't know which fork we'll walk. We understand this implicitly although others may not. An observer may conclude that nothing of substance is happening but until a decision is made, the choices weigh heavily on those who must forge ahead on behalf of those that cannot decide for themselves.


  1. I have the utmost respect for real-life doctors who wrestle with these serious matters. I talk with my daughter, in general terms, about some of the issues she deals with in family medicine. You can have all the technology and still, sometimes, there is no good choice to make.

  2. I often worry, with friends going through aggressive treatments for metastatic cancer, whether action is always warranted. Sometimes, it seems to me, patients, their families and the medical world feel better doing something -- ANYthing -- even though it's not worth it. I wonder about your thoughts on this, Kate.


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