The Mary Lou Phillips Case Jeff Phillips, the oldest son, took his mom, Mary Lou Phillips, a 73 year-old widow, to the e

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The Mary Lou Phillips Case
Jeff Phillips, the oldest son, took his mom, Mary Lou Phillips,
a 73 year-old widow, to the emergency room (ER) after her found her
confused at home.
The ER doctor and her own Primary Care Provider, a Physician
Assistant (PA), agreed that they could not rule out a stroke so
they wanted to keep her over-night for “observation.” Jeff thought
that was a good idea. He went home for the rest of the night once
he signed all of her admission papers.
She was admitted to a regular room. During the night, alone in
her room, her stroke got worse, and when the Registered Nurse (RN)
made one of her visits, she found Mrs. Phillips breathing but not
responding to commands or to pain. She immediately called the ER
doctor to check her. The RN asked another nurse to call her Primary
Care Provider and her son to come in immediately. Mrs. Phillips has
5 sons and 1 daughter, all of whom lived out of town except for
Jeff.
The CT scan showed a severe stroke, treatment was probably not
going to be helpful because of the degree of damage. The ER doctor,
RN, and PA decided to transfer her to the Intensive Care Unit (ICU)
and prepare themselves for how they were going to approach
Jeff.
The PA informed Jeff that his mom might not live but, if she
did, he and his siblings will have to make some decisions about
whether they want her to be on a mechanical ventilator to help her
breathe, if it came to that decision. He also told Jeff
that she was in an unconscious state and that could mean an
indefinite existence for her. He explained that her chances of
recovery were poor and that, if she lived, she may never regain
consciousness. The family needed to think about what type of
treatment, if any, they wanted for her. The ER physician thoroughly
explained the treatment options and the siblings’ options to
withdraw or withhold treatment for their mother. A social
worker/case manager was asked to work with the family and the team
to help resolve the issues.
Jeff frantically calls his siblings to tell them to “come fast”
and that decisions need to be made fast about their mom’s
end-of-life care. Jeff is pacing back and forth with distress and
fear because no one in his family has ever discussed these issues
among themselves or with their mother. He is afraid he will have to
make decisions before his siblings get there and he does not want
do that.
**My role for this case study is a Physician Assistant**