Dilemmas in Practice: Denied More than His Donuts

Abstract

With cheeks sunken and four days' growth of white whiskers sprouted, James Dawson lies lethargically on the bed. His eyes are closed and his mouth is set in a thin line. Crisscrossed purple streaks mark his cheeks and neck-targets for the radiation therapy he's been receiving over the past several weeks. Mr. Dawson's neck is a geometric pattern of tendons and veins defining deep hollows where pools of spilled milk accumulate when we feed him. His bony wrists are buckled into sheepskin-lined restraints, their long canvas straps tying him to the bedsprings. Protruding from Mr. Dawson's right lower arm is a plastic needle hub covered by a transparent patch sporting a sticker reading, 8/2, 22 ga, PK. It tells me when his IV was inserted, the size of the needle, and who inserted it. Just the other day, he had a duodenal feeding tube placed so we could pump formula into him 24 hours a day. Perhaps because of the depression and weakness that parallels terminal cancer, perhaps because we couldn't duplicate country cooking, Mr. Dawson still refuses to eat solid food. Unless we keep his hands tied, Mr. Dawson will pull out his IV, just as he has pulled out his feeding tube over and over. He's too weak to stand on a scale, so every day at