After writing about it, I've been pondering a bit more on what happened with Mr Johnstone and about these difficult decisions that we have to make as doctors.
You know, I really don't think that there are any answers when you're faced with this sort of situation. There is often little time to fully discuss all the options with the patients and their loved ones. Often the patient is in pain and is unable to comprehend what you are saying, let alone come to any sort of rational decision.
Luckily for me, Mr Johnstone was still lucid and could understand what was going on, but I can see situation where that won't be the case.
And the funny thing is, dealing with these sorts of decisions is not really taught to you. There's not rule book or guidelines or protocol that tell us at what point to stop offering treatment to another human being. How can there be? There are no right or wrong answers. More and more, I'm realising that you just have to get through and be guided by your own conscience and hope that you make the right decision. And here's the kicker - you never really know if you've made the right decision. You never know that things are better than they would have been had you chosen the other option.
Dr Schwab (a retiring American consultant surgeon) writes well about the thoughts and feelings that he has when faced with these decisions. His post touches on the hundreds of different things that are going through your head when you are trying to decide what is the right thing to do to help the patient in front of you.
I'd like to think that the decision making process will become easier as I become more experienced, but from the obvious mental wranglings that Dr Adams had and from reading Dr Schwab's post, it seems obvious that making a life or death decision and explaining it to those involved never gets easier.
It will always be difficult, it will always be emotional and it will always be like that because I will always care about my patients.
Mr Johnstone is dead now. I hope he rests in peace and I hope we did the right thing by not putting him though surgery. In my mind, I think we did, but like I say, I'll never know for sure.