Tatiana Fofanova is the CEO of Koda Health. She is dealing with one of the most difficult parts of health care. How do you get patients wishes in the case of end of life or other critical illness made in advance and delivered to medical professionals? Koda Health has not only figured out how to get this option to patients but also include the responses into Epic and other EMRs so that clinicians can see advanced directives and much more. She gave me a full demonstration of what is a very important and necessary tool — Matthew Holt
How to Avoid Death in the ICU
Something I learned as a medical intern is that there are worse things than dying.
As I recall, it was sometime in April, 1988. I was putting a line in an old man with end-stage kidney disease, cancer (maybe), heart failure, bacteria in his blood and no consciousness. Prince was on the radio, loud, by his bedside. If you could call it that – the uncomfortable, curtained compartment didn’t seem like a good place for resting.
An attending physician, a smart guy I respected, approached me as I completed the procedure.
“It’s kind of like Dante’s seventh circle,” he noted.
Indeed. A clear, flexible tube drained greenish fluid from the man’s stomach through his nose. Gauze covered his eyes, just partially. His head, hands and feet swelled with fluid. A semi-opaque hard-plastic instrument linked the man’s trachea, through his paper-taped mouth, to a noisy breathing machine. His skin, barely covered by a stained hospital gown, was pale but blotchy from bleeding beneath. An arterial catheter inserted by his wrist, just where I might have taken his pulse had he been healthier. A fresh adhesive covered the cotton gauze and brownish anti-bacterial solution I’d placed over his lower right neck.
“Yeah,” I said as we walked out of the room to review another patient’s chart.
