Opinion – Front Line: The case of Estrela’s father

When I arrive on duty, I am notified that eighteen ambulances were received during the day. At the entrance, people were waiting for a reassessment for a few hours, on the stretchers some recover, others agonize, everyone suffers.

Estrela sees me pass, calls my name, approaches tensely and declares embargoed: if you say you’re going to open my father’s head, I’m leaving so he can die in peace at home.

A 92-year-old man preserved some independence until a month ago, when he evolved with behavioral changes, sleepy, confused, bedridden, dependent for everything. Estrela even had difficulties moving Vitório’s body, with its nearly one hundred kilos. She needed professional support and, fortunately, had some savings that allowed her to afford an institution that cost her her monthly income.

The doctor who owns the clinic ordered some tests, including a cranial tomography that revealed subdural hematomas, collections of blood that compress the brain and compromise its functions. From the laboratory, the radiologist directed the immediate search for an emergency room.

When I arrived, Vitório was already waiting for a place to be evaluated by a neurosurgeon at another hospital. Another life in the queue at the regulation center.

I meet Estrela, she tells me she has a brother, Vitorinho. I ask to call him and the three of us meet.

Vitorinho, with his gray hair, great stature and deep voice, asks me to answer, on behalf of all the doctors, why his father was like that, because the diagnosis was not made before, what would be done from then. I say that the disease had surgical indication, but we needed to talk to define what to do with the person who has the disease. Estrela had already said that she didn’t admit that possibility. When informed that the situation could improve, she says firmly: I don’t know if my father has a chance to go back to what he was, I don’t think so, but I myself won’t go back to who I was. I don’t want to see my dad go through that ever again! He prized a lot for being independent, a lot.

Vitorinho, for different reasons, was spiritual and did not want his father to die, as he mentioned, he is also against the procedure.

I tell my children about the book Mortais (Companhia das Letras, 2015), by Atul Gawande, where the American doctor tells the story of the death of his centenarian grandfather in India in his own bed, surrounded by his family, after a head trauma and criticizes medical interventions that can add suffering to people at the end of their lives. The decision on the intervention depends on the values ​​of the people, in this case, the children, since Vitório cannot express himself. In accordance with their position, I suspend the request for neurosurgical evaluation.

Estrela decides to take her father to die in peace in the time he has in the long-stay clinic. I make a report directed to the attending physician with a diagnosis and with a proposal for proportional palliative care.

The doctor who owns the clinic gets in touch with Estrela, he doesn’t accept Vitório under those conditions. Only after surgery.

Estrela asks for a stretcher to welcome her father. What happens to Vitório is not infrequent, unfortunately. Many private clinics do not accept to take care of patients in their last moments, I do not understand a house that is intended for the permanence of very dependent people, not taking care of them in such a delicate situation and alleviating the suffering of patients and families.

In the morning, Estela looks for the owner of the clinic and reports her helplessness. helplessness. After contestations and with many snags, the doctor admits Vitório’s return.

After a few days, the Star’s father returns to the Cosmos. She contacts me and thanks, serene. Vitório left a warm bed, without grinding his teeth, beside his grandson, whom he hadn’t seen in years, and his children. We are left with the homework in medicine of redirecting our efforts to care and respect for the other, until the end.