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Cardiogenic Shock, Comfort Care and a Sister’s Last Counsel

Day 3 · 2:13:03 · Carole Avoine · Blaine Calkins · Dean Allison

  • 📉 Transferred in shock (BP 40/20) to Toronto General; vessels were too damaged for transplant and dialysis was refused.
  • 🕊️ Scott chose comfort care; Crystal, a palliative physician, had to guide her own brother’s end-of-life decision.
  • 💔 She asks what public health is worth if it abandons the human in front of you.

Final hospital ordeal and decision to stop aggressive care.

← ICD Storms, Fluid Overload and Transplant Gatekeeping | Q&A: What Would Justice Look Like for Scott’s Family? →

Transcript

Carole Avoine · 2:13:03

So he came to Barrie in May to visit us, and he knew he was in big trouble. He could barely walk, um, he could— having trouble breathing. And he got some blood work from— in Ottawa before he came, and he got the news that his kidneys were failing and he needed to go to the hospital. He did not want to go, uh, but he agreed to go, and that was on my birthday. So he got admitted to— got admitted to a hospital in Barrie. Where he had 22 to 24 kilos of extra fluid in his body.

Carole Avoine · 2:14:09

Most of it accumulated in his abdomen, not in his lungs, fortunately. Um, but the path of least resistance is wherever that water will go, and that fluid Um, and he really wanted to get home. Everyone wants to focus on what the acute issue is, of course, obviously, but we also wanted at that time to pursue a heart transplant. Scott needed to know if it was actually an option, and we had tried to pursue the option of Toronto General as, um, a new consult, unbiased, um, to see. And so after a lot of advocacy and difficult conversations with the doctors and nurses, we were finally, um, transferred.

Carole Avoine · 2:15:13

Scott was in cardiogenic shock, meaning His blood pressure was 40 over 20. He was on blood medications just to keep him alive at that point in time. The fluid was going nowhere. We couldn't— the doctors couldn't get anything off of him. And so we were transferred down to Toronto General, um, where again the most aggressive measures that they tried We're doing nothing. So we got news that he needed dialysis, and Scott did not want that. He did not want dialysis. But the question was, if he gets dialysis, could he still qualify for a heart transplant? And at that point in time, there had been so much damage to all of the blood vessels leading into and out of his current heart that there— he couldn't have received a heart anyway.

Carole Avoine · 2:16:17

So at that time, he chose not to pursue dialysis, which would have only given him a little bit more time anyway. And he was suffering. He was in hospital away from his kids. With tubes everywhere, uncomfortable in a hospital bed, not surrounded by family. So he made the decision, um, to just pursue comfort care. And I had the conversation with him that helped him choose that because I'm a palliative care doctor. That's what I do for a living, or I did.

Carole Avoine · 2:17:21

And I don't know if you can imagine what that— how difficult that was. Or what that felt like. I think if there's anything that I leave you with about that. If we're not focusing on what's best for the human in front of you, what are we doing? You can have public health all you want, but public health is made up of individuals.

Blaine Calkins · 2:18:20

Crystal, can I, can I interrupt you? It's just we're getting short on time and I know some of the MPs want to speak with you. Absolutely.

Dean Allison · 2:18:32

Mr. Motts.