During my residency I spent 6 consecutive months at a downtown Catholic Hospital. The first three months were anaesthesia which was a fantastic experience. The second three months were on the internal medicine service which was an ordeal of one in three call which I am still proud of surviving but bitter about having to do. One patient who stands out from those six months was The Judge.
Every time we encounter a member of the legal profession our collective assholes all go into spasm. This is really not necessary. Lawyers are for the most part well educated people who actually understand tort law, realize how much frivolous litigation will cost them and how little chance they have of succeeding. The upshot is that lawyers tend to actually get worse care; they get over investigated which generates further investigations and procedures; their care seesaws between overly conservative and overly aggressive. I suspect that about 50% of anaes. would for example not put an epidural in a lawyer for fear of a lawsuit, whereas we would all like one ourselves.
Judges in Canada are all appointed either by the federal or provincial governments. This is usually but not always done after consulting the legal community. Some judges are eminent lawyers or legal scholars, some are involuntarily retired politicians and some are appointed in recognition of their service to the ruling party. For all its flaws the system more or less works.
There is a feeding chain of judges going from Supreme Court judges down to family court judges and justices of the peace (who often aren't even lawyers). Often when a judge is in hospital we refer to them as "The Hanging Judge" although Canada to its credit hasn't strung anybody up since 1962.
I don't know what type of judge The Judge was or what his qualifications were for his bench.
The judge presented to the thoracic surgeon at our downtown Catholic Hospital (DCH) with lung cancer. Sadly this was unresectable even for our thoracic surgeon who was known for his heroic procedures. When told of his grim prognosis, The Judge told the surgeon he wanted no aggressive treatment. This would have been nice, if the surgeon had actually written a note in the chart, however when The Judge went into respiratory failure about a week after his diagnosis, the internist on call had him intubated and put on a ventilator.
Did I mention that two of The Judge's sons were lawyers?
This lead to 4 months of sheer misery for the The Judge. He was in and out of ICU, trached and had multiple line insertions (usually with no sedation or local anaesthetic). I myself inserted several lines in him. I remember during lucid intervals he would have a most malevolent look, the type of look he would have reserved for when he was sentencing someone to death (if he could do that in Canada). At one point during a brief period out of the ICU on the ward, he told one of the interns that he had been going through hell.
Being a judge, there were always jokes about him being a judge. I remember once when he had gotten off the ventilator and was sitting in a chair in ICU, one of the internists remarked that all he needed was his robes. One of the nurses told me she was rolling him, thinking him our of it and called him "judgey poo" at which point he opened his eyes.
Despite everything he was gradually not surprisingly dying of cancer. Eventually he developed brain mets. Despite everything no DNR order was ever written (or as far as I know requested). I wasn't on his service and only covered him at night so I have no idea about what discussions went on with his family.
I was on call the night he died. He was by this point in the CCU, the ICU being full. The CCU nurses called me quite concerned because they felt he was going to die soon, there was no DNR order but they did not feel comfortable running a code. I told them, when he arrests, don't call a code, page me, I will call the code off and say we did everything we did. This is in fact what we did about 2 hours later.
One of the interns told me later that he had overheard a conversation between The Judge's two lawyer children to the extent that, "He was a bastard to us and look how we have made him suffer." I didn't actually hear the conversation, I hope it actually didn't occur although it does make for a good story.
I must check out my personal directive.
Every time we encounter a member of the legal profession our collective assholes all go into spasm. This is really not necessary. Lawyers are for the most part well educated people who actually understand tort law, realize how much frivolous litigation will cost them and how little chance they have of succeeding. The upshot is that lawyers tend to actually get worse care; they get over investigated which generates further investigations and procedures; their care seesaws between overly conservative and overly aggressive. I suspect that about 50% of anaes. would for example not put an epidural in a lawyer for fear of a lawsuit, whereas we would all like one ourselves.
Judges in Canada are all appointed either by the federal or provincial governments. This is usually but not always done after consulting the legal community. Some judges are eminent lawyers or legal scholars, some are involuntarily retired politicians and some are appointed in recognition of their service to the ruling party. For all its flaws the system more or less works.
There is a feeding chain of judges going from Supreme Court judges down to family court judges and justices of the peace (who often aren't even lawyers). Often when a judge is in hospital we refer to them as "The Hanging Judge" although Canada to its credit hasn't strung anybody up since 1962.
I don't know what type of judge The Judge was or what his qualifications were for his bench.
The judge presented to the thoracic surgeon at our downtown Catholic Hospital (DCH) with lung cancer. Sadly this was unresectable even for our thoracic surgeon who was known for his heroic procedures. When told of his grim prognosis, The Judge told the surgeon he wanted no aggressive treatment. This would have been nice, if the surgeon had actually written a note in the chart, however when The Judge went into respiratory failure about a week after his diagnosis, the internist on call had him intubated and put on a ventilator.
Did I mention that two of The Judge's sons were lawyers?
This lead to 4 months of sheer misery for the The Judge. He was in and out of ICU, trached and had multiple line insertions (usually with no sedation or local anaesthetic). I myself inserted several lines in him. I remember during lucid intervals he would have a most malevolent look, the type of look he would have reserved for when he was sentencing someone to death (if he could do that in Canada). At one point during a brief period out of the ICU on the ward, he told one of the interns that he had been going through hell.
Being a judge, there were always jokes about him being a judge. I remember once when he had gotten off the ventilator and was sitting in a chair in ICU, one of the internists remarked that all he needed was his robes. One of the nurses told me she was rolling him, thinking him our of it and called him "judgey poo" at which point he opened his eyes.
Despite everything he was gradually not surprisingly dying of cancer. Eventually he developed brain mets. Despite everything no DNR order was ever written (or as far as I know requested). I wasn't on his service and only covered him at night so I have no idea about what discussions went on with his family.
I was on call the night he died. He was by this point in the CCU, the ICU being full. The CCU nurses called me quite concerned because they felt he was going to die soon, there was no DNR order but they did not feel comfortable running a code. I told them, when he arrests, don't call a code, page me, I will call the code off and say we did everything we did. This is in fact what we did about 2 hours later.
One of the interns told me later that he had overheard a conversation between The Judge's two lawyer children to the extent that, "He was a bastard to us and look how we have made him suffer." I didn't actually hear the conversation, I hope it actually didn't occur although it does make for a good story.
I must check out my personal directive.
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Making preop rounds in CCU, I overheard two nurses discussing the fact that Mr. X had died. "His wife was so devoted." cooed nurse A. Nurse B started to giggle. "I met her in the lobby after he died." she continued, as nurse A looked interested and confused. " I offered her my condolences for her loss of her husband." Now Nurse B is laughing so hard she can hardly continue. "His wife leaned forward, took my hand, and said "He was such a mean SOB, I appreciate you girls being so kind to him." Both nurses agreed about the wife's assessment!
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