Recently, I found myself in the intensive-care unit perched above a 91-year-old man plunging a large needle into the side of his neck in order to place a catheter into his jugular vein.
The catheter would wind its way toward his heart and allow us to infuse medications to bring his blood pressure up. For a physician, this can be an incredibly satisfying procedure, but in this case I could not slow the refrain in my head that told me, "You are torturing this man."
As a physician, I frequently confront situations like this. A patient nears the end of his or her natural life, and I am left wondering whether the lifesaving treatment is helping or hurting.
When I met the patient and his family in the emergency room, I heard a familiar story: the slow ravages of dementia, the falls at home, hospitalizations for pneumonia and most recently a broken hip.
Pain medications had made him confused and agitated in the hospital a week ago, so he was taken off them and left to writhe in pain at a nursing home where he ostensibly was undergoing physical therapy to get better.
I took the time to ask his family about him in better days. He had been a proud man, served in the Pacific during World War II, raised four children, saw his wife of nearly 60 years through cancer, then death.
He looked close to death himself — eyes rolled back, mouth agape with dried spittle and blood at the corners, his breathing shallow and fast. His chest X-ray was almost whited out, suggesting a combination of pneumonia and fluid backed up from a failing heart.
I laid it out to the family in no uncertain terms. Their father was dying. If we pursued an aggressive course we would need to intubate: insert a large tube down his throat into his trachea and allow a ventilator to breathe for him.
