Rewatching Episode 2

I started rewatching the series from the beginning and I got to Episode 2, specifically the part where the brother and sister are debating on whether or not to intubate their elderly father. For some reason this scene in particular, more than any others really stuck with me. I’m a physical therapist in a large level 1 trauma center, I rotate between the ED and general medicine units and while I can’t relate to a lot of the medical scenes in this show (and thank god for that lol) this situation is something I unfortunately deal with on a weekly if not daily basis, so I thought I’d give some perspective.

PTs and the therapy team in general (OT, SLP, etc) evaluate patients and make recommendations for discharge. Specifically for PT: is the patient moving well enough to safely go home, do they need rehab first, or do they need something like long term care (nursing home in layman’s terms). PT and OT are consulted services, meaning that physicians and other team members put in an order for us to see patients. Oftentimes, it’s run of the mill cases like pneumonia, sepsis, etc but very often we get consulted for things like “Failure to Thrive”. These are cases where the patient is (often) 80+ years old, has no quality of life left, and frankly needs end of life care. But, just like in the show, families can’t accept this and instead they badger the medical team to consult PT to get their dad walking again (even though he hasn’t walked in 6 years). So, to appease the family, we go in and do our evaluation which consists of basically lifting the patient from supine and supporting their mostly limp body in sitting at the edge of the bed for a minute or two before laying them back down and recommending the patient go to a skilled nursing facility at discharge - assuming they ever discharge.

As I think about this it makes me feel ill. Thankfully I’ve never had to do CPR on someone and I hope I never do, but the feeling of lifting and maneuvering a frail elderly person’s body (who clearly does not want to move) is something that is burned into my memory like I imagine breaking ribs with CPR is for some people. I feel awful for the patient, I’m making them uncomfortable in what could be their final days just because their family member thinks “papaw’s a fighter, he’d not want me to give up on him.” I say all this to say: please consider what you’re doing to not only your loved one but also healthcare workers when you’re deciding end of life goals. I’m really glad the show touched on this because there are so many cases in recent memory where a patient would pass peacefully with hospice care but instead dies confused and in pain. Anyway, just needed to rant. Shoutout to the hospice and palliative care peeps, you’re the real MVPs