Randall's therapy had not been working, but the nurses on the new shift didn't know that—they didn't know Randall—and followed the doctor's standing orders.
"As a lover, I was keenly aware of the dramatic changes that had happened to him within a 24-hour period," Geary says. "I pleaded with the nursing staff to take note of that." Even when he convinced the charge nurse to call the doctor, she wasn't able to clearly communicate the changes in Randall's condition over the past 24 hours because she had not seen them first-hand.
"I called the doctor myself and I said, 'Something's not right—you really need to get in here. I think he's going to have a heart attack or go into respiratory arrest very shortly.'"
The doctor moved Randall to intensive care. But once he was stabilized, nurses wanted resume the same standing orders that Geary believes put Randall in jeopardy. Geary, as Randall's healthcare surrogate—refused the treatment. Geary believes if he had not had the courage to speak up, the treatment would have hastened Randall's death.
Although many believe that stronger physician-patient partnerships could improve quality of care, the old doctor-as-God model is still too common, Geary says.
"Some people are basically arrogant and it is 'physician or head nurse knows best.' When you come up against that it is difficult to assert yourself, particularly in a weakened physical and emotional state to advocate for yourself. I think that was one of the tremendous benefits of Shanti volunteers is that often they could advocate for a patient when the patient was not able to advocate for themselves," he says.