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This particular case was a man who came to the ER in respiratory failure, but with so many other problems that he was almost a one-man Merck manual. Diabetes, end-stage kidney disease, peripheral vascular disease, and chronic obstructive pulmonary disease were just the high points. He’d recently lost one leg above the knee because lack of circulation led to gangrene, and the suture line looked horrible, dead for an inch on either side. The other leg was looking pretty much the same way, necrotic just about all the way around the calf. Necrotic areas on the fingers, too. Decubitus on the sacral area darn near to the bone. He’d been getting tube feedings but hadn’t been tolerating them, so they were suspended. He’d been on the vent long enough to be trached and for the trach to be nice and solid and not draining any. He was barely responsive, only withdrawing to painful stimuli, would open his eyes at random but didn’t track, didn’t follow commands and barely moved at all, certainly not purposefully in any way except for the withdrawal. A recent EEG wasn’t flatline, but showed diffuse slowing, in other words very little brain activity. Most of us would call him “dead on the vent.” His family (wife and numerous kids) has been told, in very blunt words, that there is no hope of recovery, that he’s not really in there, yet they don’t seem to get it. “But he opened his eyes and looked at me!” (No, he just happened to be turned that way) “But he moved his hand when I touched him!” (He withdraws from all touch) So we continue to maintain him on the vent and on dialysis three times a week, and we do all sorts of things to him, many of which are painful.and pain is the only thing that seems to reach him. Why? I think the short answer is “because we can, therefore we have to.” Nobody, least of all the family, seems to be looking at his quality of life, and no one will make the decision to do the compassionate thing, to stop all the painful treatments, stop his dialysis, keep him comfortable, and let him go peacefully. After all, his heart (an electromechanical pump) is still beating, and could go on beating for a long time, even if his brain did go flatline, so he’s “alive.” Right. Lying there rotting while a machine breathes for him and three times a week another machine filters toxins from his blood because his kidneys don’t do that any more. Where’s life in that?

I have informed my children if they even consider doing such things to me when I can’t protest, I will sit on the heads of their beds and haunt them for the rest of their natural lives. Think about it. How much would you torture someone you loved if you knew there was no hope of recovery? And if you haven’t already done so, make your advance directives so no one will do the same to you.