The Locked Cell Phone

Dr. Zach

2018

Thursday afternoon, 2:45pm

A 45 year old woman has the sudden onset of a severe headache at work.  She asks a colleague for some Tylenol. 10 minutes later she starts to vomit, and then she collapses on the floor, unconscious.  Her colleagues call 911, who instruct the bystanders to check if she is breathing and has a pulse. She does have a pulse, and is breathing, but is completely unresponsive.

The ambulance attendants comes and find her as described.  Her heart rate is normal, blood pressure is very high, oxygen level normal.  They rush her to the hospital. The doctor inserts a breathing tube (intubates her) to protect her airway (to make sure she does not choke and to make sure she does not stop breathing).  Blood tests are drawn and an emergency CT scan of her head is performed. It shows that she has massive bleeding in her brain, likely from an aneurysm that burst. Neurosurgery is called and it is determined that surgery is futile; she will not regain consciousness, probably ever.  If she does she will likely be left with severe brain damage. The neurosurgeons suggest allowing her to pass away, which would mean removing the breathing tube (if not for the machines she would pass away, ie they are keeping her alive). The healthcare team is not comfortable making that decision without knowing what the patient, or her family, would want.  The patient cannot tell them. And she arrived with no identification. No one knows how to contact her family. But the patient has a smartphone on her. There is a fingerprint scanner on it. The healthcare team are in a quandary — do they unlock her phone using the woman’s finger, and thereby see her information and contacts, without consent, or do they continue to try to figure out who she is and who her loved ones are in other ways?

A few comments about this case:

1. It is not uncommon for emergency personnel to have to treat people with no identification.  Usually they are found outside, sometimes intoxicated. It is always better to know someone’s past medical history, medications, and allergies in order to treat them properly.  Even when the person has identification and can speak, it is not unusual that they do not know their past history or medications. Provinces and states are establishing systems whereby people’s medications and health information is accessible to healthcare professionals when they need it.
2. A problem that arises not infrequently is when the treating team does not have information on the patient but needs to make urgent treatment decisions, such as with respect to resuscitation.  The default is to always resuscitate a patient. But if someone does not want this then the treating team could be held liable, especially if the person lives with long-term disability thereafter.
3. Many people have not discussed or have not formalized advance directives.  It is hard to think about and often life-threatening situations are a big surprise.  Even if there are advance directives they have to be available at the time of the potential resuscitation, which means a loved one has to be available with them.

Please see a related article about the DNR chest tattoo.

1. It is sad to learn how many people are alone, with no family, no friends and no supports.  Loneliness is a big problem, especially for older adults, and it is a growing problem.

Ultimately the phone was unlocked using the fingerprint.  Friends and then family were contacted. They came in, saw her, and began to grieve.  Ultimately the decision was made to withdraw care and the woman died. It was terrible.

This case highlights some difficulties with access to personal information (what if the patient had very sensitive information on her phone that she would never want anyone to see?) and to health information.  The more the treating team knows about a person’s health information and wishes, the better.

 
Image by Free-Photos from Pixabay