July 22, 2011. Medicine: DEATH

Today at the hospital we got to deal with one of those life and death ethical situations that you learn about in cheesy "medicine, patients, and society" classes that most blow off. Turns out those classes are pretty useful.

This patient is an older man on a ventilator, unable now to breath on his own. He has a wife and children here and other children in other parts of the world. They do not speak English. They also are from a culture that views surgery and intervention as extremely dangerous. One family member referenced someone in their family who had a surgery and died when we were discussing his need for a permanent trach tube and a line into his stomach to feed him.

When we rounded on him in the morning, the sedative was letting up some and he was responding to our requests to raise his eyebrows, close his eyes, etc. Because he had a tube in his throat and was restless we turned up the sedation.

Suddenly three of the daughters arrived. We explained the situation and they argued over what to do. One wasn't ready for him to die, the other said he would never want to live like this. We explained we could send him to a nursing come cognitively intact but with a trach tube and a tube to his stomach. They argued, we asked where the wife was. She was in NY, somewhere, but old and unable to easily travel. We finally explained that if she were to come to the hospital, she could decide on what to do with him. Otherwise, all the 10 children would need to sign that they agreed with extubating him and letting him die.

Finally, the wife came and made the decision. She said he didn't want to live like this, and that was that. He will die on Sunday, when they remove the tube and say goodbye. I could go on forever about how we keep people alive for way too long, thinking "being alive" is the same as "having life." If we wanted, we could keep blood clean (dialysis) and lungs breathing (ventilators) and blood pumping (bypass) for years and years...Sadly, many people don't have living wills (directions as to what to do) or a "health care proxy" - someone designated as the decision maker.

Make someone a health care proxy today...let them know to the best of your ability what you would and would not want to live with, and then fill out your states papers showing this. Then let your family know. This way, one person is clearly in charge, and if your wishes are known to the family, there isn't much to argue about come that ill-timed moment that many people haven't planned for. We all die, so there is no harm in talking about it now to make it easier on everyone.

I went to look for Rico but he had been discharged to come back to the Onc clinic.