Case shows hospital met patient's request

A recent case in the ED at St. Joseph's Regional Medical Center in Paterson, NJ, shows the value of its new Life-Sustaining Management and Alternative (LSMA) services, says Mark Rosenberg, DO, MBA, FACEP, chairman of emergency medicine and co-creator of the program.

The patient was 56-year-old male with stage IV lung cancer who was having difficulty breathing. He had been through chemotherapy, but it was no longer efficacious. His oncologist had told the family there was nothing more he could do.

Rosenberg met with the patient and his wife and reviewed his history. He also presented them with alternatives. "The hospitalist was going to admit him, probably drain the malignant effusion in his chest, and put him in the ICU, where he may have died," he said. When Rosenberg explained the circumstances to the patient, "he was excited ... happy. He knew he was dying and just wanted somebody to say it and know what was in store for him," he says.

The patient decided he would rather go home. Rosenberg arranged for hospice care. "We also got him to tape record messages for his nieces, who were 1 and 3, and for others, so he could leave a legacy for them," he notes. "We also had family meeting, and to this day the family couldn't be more thankful that we let him have a choice and reach his goals."

The patient died at home three weeks later without medical support.