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Facing Mortality: Life and Death in the ICU

Heavenly image of clouds and sky; life and death in critical care.




Last week, our medical team found itself between a rock and a hard place. A patient, who had come in with serious pneumonia had gone into respiratory failure. The patient was pushing a century, yet despite her compromised health status and her advanced age, her offspring – the primary health proxies – wanted everything done.

She was intubated.

Days went by with subsequent failed breathing trials, her children by her bedside, telling her to get through this. The possibility of a full recovery decreased on a daily basis.

She was not getting through this. This frail, elderly woman would eventually need a tracheotomy to create a permanent artificial airway to hep her breathe. She also had severe dementia. She was unable to eat in order to maintain an adequate nutritional status. She would need a tube surgically inserted into her abdomen to provide her with nutritional support.

Ironically, despite all this, her heart was strong, so medically she was objectively cleared to undergo surgery. Because her level of dementia categorized her as someone with no capacity to be able to make her own decisions, and she had no advanced directives, her children were in charge.

After multiple conversations with several members of the medical ICU and palliative teams and her nurses, the children, ridden with guilt, refused to consider the eventual, inevitable option of saying goodbye without undertaking extreme measures.

“I need to feel like I have done everything I could,” her son stated tearfully in one of these meetings, as he held his mother’s swollen hand, blue and bruised from the restraints needed to hold her down in order to not pull out the tube that was keeping her alive.

These kind of scenarios happen on a daily basis in ICUs across the country. Today at least 25% of health care spending in the U.S. goes to the 6% of people who die every year and ICUs account for 20% of all health care costs. Although human life at every age and in every condition is priceless, it is, inevitably, temporary; so when is it time to stop fighting nature? There is no magic number that we doctors can objectively rely on; we have no right to give families the green light to completely give up hope. Although we come close to playing God, we are after all not God. So we resort to empathizing … “If this was my mother, if this was my dad…”

An ICU stay is typically a blur of tubes, needles, IVs, and pumps. For the very elderly it is an invasive experience, with noisy pumps and heart monitors going off at all hours throughout the night, and a constant parade of medical staff shuffling through. With every patient and family I have seen through the pain of these decisions, these situations beg me to ask: If patients and family members saw what went on behind the scenes, would they be more willing to let go? If they knew how common their decisions were universally, if they understood this was just nature taking its course, would they feel less guilty? If the conversation had been ongoing for years, would they consider parents, grandparents, and loved ones to breathe their last breaths sooner, without the pressors, the needles, the tubes, the pokes and tube after tube of bodily fluids?




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11 Comments

  • Reply
    Jonathan
    March 20, 2017 at 1:55 pm

    It is really sad that people have to go through stuff like this. For the patient. For the patient’s family and friends. For the hospital people. This is why I wish, if I do reach old age, to just die peacefully in my sleep. Plain and simple.

  • Reply
    Samantha
    March 20, 2017 at 7:46 pm

    My 85-year old grandpa was in the same situation five years ago. He was in the ICU due to pneumonia. We had to let him go eventually because his body was so weak and we don’t want him to suffer anymore.

  • Reply
    Marissa
    March 20, 2017 at 8:28 pm

    Palliative care would have been a better option in this case. Considering the age and dementia, the patient’s children should understand what quality of life their mother would have after surgery. Is it a life that she’d want too?

  • Reply
    Giovanni
    March 20, 2017 at 8:32 pm

    I salute all our healthcare workers who face this situation on a daily basis. It’s a physically- and emotionally-demanding job. Nurses, in particular, are heroes!

  • Reply
    Kitty Pryde
    March 20, 2017 at 11:43 pm

    This is beyond health anymore but an interesting subject. It gives us glimpses about is there life beyond. My opinion ok.

  • Reply
    Kurt Wagner
    March 20, 2017 at 11:47 pm

    Nice read for a very deep topic. It is now lent so its very timely.

  • Reply
    Kaitlyn
    March 21, 2017 at 6:21 am

    Such scenarios are truly painful. No one wants to be in that situation. Personally, I would do the same. Letting go is hard but seeing a loved one suffers is much harder. If God wants us to live then life support should not be necessary.

  • Reply
    Maripaz
    March 22, 2017 at 9:53 pm

    I reckon when a patient is sent to the ICU, the family would already have the understanding that their family member might not make it. Thus, there should already be acceptance for whatever happens.

  • Reply
    Rashid
    March 22, 2017 at 9:56 pm

    Initially, I wanted to become a nurse. I love the idea of working in a hospital. But when I realized I could be assigned to the ICU, I changed my mind. I don’t have the heart to survive this kind of scenario.

  • Reply
    Kyo Kusagi
    March 22, 2017 at 11:26 pm

    Can you really consider living off a machine living? They always say I will mot let them die so much so that a machine is now his life. Sorry but my answer is no. Depending on machines is not life it never is.

  • Reply
    Kadoya Tsukasa
    March 22, 2017 at 11:29 pm

    This puts nurses and doctors to a new light. A lot is all about money but in reality, Money is just secondary . Saving lives comes first.

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