It is difficult to Eusebio to get up early.

It is a cold day and he feels tired. He would prefer to remain in the bed, waiting for his daughter to bring to him the meal and watching peacefully the television. This would be a good plan. But he knows that in the next minutes the stamp will sound, the boy will greet him as usually and he pick him up in a wheelchair to take him to the hospital in an ambulance. Before coming to destination, they will gather Paquita and Roberto, tired and lazy like him. It´s Monday and the week begins, exactly as the previous one.

After arriving to the hospital, they leave them.

– ‘We park you here: ok?, Opposite to the dialysis room’.

– ‘Good morning, we will attend you now. How are you?’.

– ‘Everything as usually, I do not know if that´s is good or wrong’.

– ‘Cheer you up Eusebio, I have heard your grandson is going to come and visit you in holidays’.

The routine begins, surrounded with persons with citrine color and boring aspect. Television speaks, the nurses speak and doctors walk from one side to the other.

– ‘Eusebio, the last analyses are a little shaken, we are going to change a little your treatment… We will explain all the changes to your daughter.’

In the opposite position there is already not the biggest man who was very sick. Eusebio does not dare to ask, but in the wardrobe he has heard that he died. How has happened? Peacefully at home? Did he suffer a complication and spend his last days in the ICU?.

Eusebio would like knowing … Because he realizes that the next one can be himself. But now it is time to think about the visit of the grandson, in the meal that its daughter has prepared for him (she is a great cooking!) and on Wednesday football match. That is what makes him enjoy, and very important for him. If doctors and nurses do not say anything to him, he assumes that everything works.

But Eusebio would like to be prepared, knowing what he would feel when things go badly, where he will be. He does not want to sadden its daughter speaking about it, and doctors … All of them are very nice but they are very busy. ” There will be my things” , thinks Eusebio, trying to relax looking at the television, although he is not interested on it.

Patients with chronic renal insufficiency in dialysis program spend more than 600 hours a year in the hospital. They want to speak about the end of the life but we do not give them the opportunity to do it, because of lack of time or relationship skills. We are as the coachs of basketball who do not request a time out to re-lead the team, our patients and their families.

My collaboration as intensivist and keen of the bioethics has tried to stop and converse with a patients’ small sample and their families.

You can read the summary of the work in the article Stopping the Dialysis in patients with Advanced Chronic Renal Insufficiency: What do patients think?.

Dr. Iñaki Saralegui (@InakiSaralegui)
Intensive Care Phisician.

President of the Ethics Committee Care
Hospital Universitario de Alava.