A 99 year old gentleman came into the hospital in respiratory distress from a local nursing home where he resided for many years. He was not alert or awake. His family rarely visited. The patient got to the point that to avoid imminent death, he required a ventilator to help him breath, though it was clear to everyone he was near the end of life. The physician and the family insisted on “doing everything possible” to keep him alive and avoid death. The physician had his own reasons. You see, he visited the patient every day in ICU and billed Medicare (I don’t say this about all physicians but there are many out there that care nothing about protocols or best practice or outcomes; only about the billing). The family had their reasons, which appeared to be the check that they were collecting and using for their benefit. Meanwhile the patient, who could not voice his opinion or desires, suffered under our hands.
Instead of providing him with comfort care (the most appropriate care given this situation), we took care of him for 30 days in ICU while we poked and prodded. We tied his hands down so he would not pull out any of the tubes. We turned him and cleaned him, all the while no one visited and we received our orders from the family via the phone. Finally, the decision had to be made to either perform a tracheotomy or take him off the ventilator. The decision was made by his family and physician to perform the tracheotomy. It was done. We finally transferred him to a long term acute care hospital where he died about a week later.
He never received the care he should have received which was patches to decrease his secretions, pain medicine to ease his respiratory distress, music to sooth his soul and the support of a team that knows how to care for the dying. He should have had hospice care.
We in the health care field can be very good at providing lots of high tech interventions to patients who are clearly dying but why? I often say when patients are receiving care that is futile…. “We are not extending life…We are extending dying.”
At this point, many will say “it is not for us to decide and play God, we need to let God work.” To that point, I say to every patient/family that I have ever had an end of life conversations with, “Life and Death is not in our hands”. To stop futile care (removing a ventilator) does not mean a patient will die. Many times they don’t. But by determining the best care, we provide better care for the patient. If you have ever been on a ventilator, you will know what I am talking about.
It is amazing how everyone evokes God’s name to insist that every technological advancement in health care should be used. When protocols and standards show it won’t help, why can’t people let go of control of trying to heal patients without God. Where is your faith? God is the master healer. He does not need healthcare to heal, although he has used it many times. But when it is futile, why not turn to the only one that holds hope in His hand? Withdraw the futile care and let God decide who lives or dies.