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Frustration:

Posted Sep 14 2009 10:02pm

I was working in one of our ICUs last week. One of my patients was a kindly little old lady of 96 years. She was a soft-spoken, tiny, shriveled little thing, but she was sweet and alert and fully capable of interacting with the staff beyond the usual condescenscions of “Awww she’s so CUTE.” If one were to actually talk to her like a human being instead of talking down to her like so many healthcare providers do, she was just the coolest person in the ICU. A youngun’ like me can learn from a soul of 96.

At 96 years old, she was ready and prepared to pass away. “I don’t want to live forever,” she told me. “I’ve done what I needed to do.” She had a fully signed and witnessed DNR/DNI form and wanted no aggressive care.

Her family, a staunchly religious group of people, would hear nothing of it. They demanded that we do everything for their mother. They wanted ABGS, they wanted full-blown diagnostics, they wanted a dramatic full-on assault. Despite their mothers pleas that she wanted to be left alone to live out her final days in peace, they talked over her and demanded that she rescind her DNR, which she refused to do.

The attending physician agreed with them, talked with the patient, and ignored her. The nurse and I were at the bedside when he was trying to talk this awake, alert, competent, and reasonable 96-year-old woman out of her DNR. Her nurse couldn’t take it any more.

“Do you want all of this, or do you want to go home?” she asked the patient.

“I want to go home. I want to go to heaven. I don’t want any of this.”  The doctor, not one of my favorite clinicians, stared at her in disbelief.

“Get me a psyche consult, and an ABG.”  I was dumbfounded. The nurse got red in the face and raised her voice.

“A PSYCHE consult? You’re the one who needs a psyche consult! This lady is perfectly capable of making her own decisions!”

“It’s not normal to want to die! Just because she wants to go doesn’t mean we can push her off the cliff!”

At this point I interjected.

“We’re hardly pushing her off a cliff. Everybody has to die sometime. She’s 96. She’s a grown-up. She can make her own decisions.”

“Well, I don’t think it’s normal. I want a psyche consult. And an ABG. She must be hypoxic or something.” I stared at him, amazed. My fists clenched. I wanted to punch him in the face. “I’ll be sure to get right on that,” I told him, and then I walked away.

—-

I  never did get the ABG on that patient. Psyche came to see her, declared her competent to make her own decisions, and left. Last time I saw her, her family was still trying to weasel us into doing drastic measures for their mother. They called in their priest to try and guilt her into rescinding her DNR. They prayed over her bed and asked God to expel the demons from her that were possessing her. I believe in God but I don’t believe in the kind of religion that warps a mind that badly; there’s nothing holy about what those people were doing.

I hope to God we didn’t do anything drastic after I left my shift. That lady was ready to go, and if her time was up, I hope we let her go in peace instead of subjecting her to the horrors of the modern ICU that she explicitly stated she did not want.

Why is it so hard for people? Why is it so hard for Doctors of all people? Somewhere I heard the phrase “All that lives is born to die,” and there’s a lot of truth to that. I know that it’s hard to say goodbye, but the fact is that nobody on the planet will live forever. Knowing that your loved one has to die, why would you deprive them of their autonomy in the last days of their life? Why would you inflict on them sufferings that they have specifically asked to avoid? Why would you do that to someone? There’s no going back from that, no time to heal those wounds. You put your loved one through something they didn’t want, and then they die, there’s no time for them to forgive you.

Sometimes, what we do in the ICU makes a world of difference and can recover someone, lead them along the first steps to the road of recovery. I’ve seen patients in the ICU do exceptionally well and come walking back in, months and months later, to say thank you. But there’s a dark side. I’ve seen us do a lot of painful, pointless things to people who will never recover. And thinking ahead to my own eventual demise, I can only hope that when the time comes for me, it’s a natural and peaceful end to a life well lived, not a chaotic and frantic death amid the insanity of the ICU.

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