Chapter 1
Years ago, a 101 year old woman arrives by ambulance. Shortness of breath with an altered mental status. Clinically, she has pneumonia and bacterial sepsis. Her daughter arrives and says she wants everything done for her mother: intubation, ventilator, antibiotics and the rest of the full court press. I talk about the option of making her mom comfortable rather than putting her through an invasive hospitalization with only a remote chance for survival. The daughter is adamant, and I abide by her wishes.
Two hours later, a 105 year old woman arrives extremely short of breath and vomiting feculent material. This pretty much declares a bowel obstruction, and she has undoubtedly aspirated her own feces, which is about the worst thing a person can aspirate. And surprise!! It’s the first patient’s older sister and the niece is her durable power of attorney. Déjà vu, I’m sitting in the office having the conversation, but this time about her aunt. I am colder and more calculated as I tell her that in all my years of medicine, I have never been more certain that a patient is going to die. She still wants every measure taken. There is a thing about a physician not having to provide futile care. But in the heat of battle in an emergency department, it’s problematic to implement. I practically beg. Don’t do this, let me make her death comfortable and dignified. She insists, and I am forced to engage in what I consider to be a crime against humanity.
