ECHO Communication Session
July 13, 2023
Station 1 – Artificial Nutrition & Hydration
Instructions for Surrogate – Patient’s son, Joshua Wong
You are the son of [Link]. You understand that he has multiple illnesses including End
Stage Renal Failure, heart failure (lemah jantung), diabetes (kencing manis), and stroke. He had been
on dialysis for 10 years, but this was complicated with recurrent infections. He is no longer suitable
for dialysis due to his weak heart and has recently become bedbound with due to stroke. His
nephrologist has counselled the family and dialysis has been withdrawn 10 days ago and he was sent
home.
Since coming home, your father’s condition has deteriorated by the day, and he now has
generalized swelling, worse in the tummy and legs. He is also getting more breathless and you feel
helpless looking at his condition. He is completely bedbound and dependent on your care.
You are very concerned about his condition and you feel that he is becoming weaker
because he is not eating anything much. You are trying your best to force him to eat more but he
refuses to swallow, and you notice that he seems to cough every time he drinks water or eats
porridge. He has not been able to swallow for the past 2 days.
You call the clinic nurse to make an urgent home visit so you can help him to eat/drink. You
ask the nurse if it is possible to put a feeding tube so he can receive nutrition through the tube, just
as you have seen others in the ward. You feel he will get stronger if he has more nutrition and he will
be able to get better. Perhaps he can even start dialysis again. You cannot bear to see him fade away
and want to try anything to prolong his life.
Your real concern – (this will only be mentioned once an empathic statement is mentioned
i.e. It must be very difficult to see your father in this condition OR This must be hard for you OR I
cant imagine what you’re going through)
- You have seen your father recover from multiple ICU admissions in the past from various
infections and feel that he is a “fighter”. You were not happy with the nephrologist’s
decision to stop dialysis, but your father seemed to agree with it.
- You feel like you are failing your duty as a son if you do not let him continue fighting.
Questions to ask:
1. Can you please insert a NG tube for feeding? Won’t he suffer if we don’t feed him?
2. Why don’t we set up a glucose drip for him instead?
3. If the nurse explains his condition and that NG feeding is not suitable at the end of life, ask: So
how long do you think he has?
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ECHO Communication Session
July 13, 2023
4. How to end the consultation:
- If no empathic statement issued, try to appear concerned until the end. You can accept
whether or not NG tube is agreed upon but show your concern that you feel not enough is
done for your father and you wish more could be done.
- If an empathic statement is issued, thank the staff for explaining and acknowledge that you
really have no experience in issues such as this.
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