poured out before bed
“He’s getting pretty bad…we may have no choice but to intubate him soon,” the fellow circles a few values on the ABG and looks through the glass door at the severely underweight 30-something leaning into his face mask, oxygen on full. ”And we may not be able to extubate him this time.”
The senior resident nods and flips through the chart.
“He still doesn’t have a POA…and no advanced directive, either. I know last time he was here we discussed that this situation was coming and that he really should make his wishes known before it did… He wanted none of it.”
Both young men, men the same age as the patient concentrating on breathing in the ICU bed, sigh. I follow the senior into the room where the patient sits with his wife and brother. They are so used to this environment they look stoic, nonchalant even. Wife flips through an issue of Cosmo. Brother is absorbed by scenes from an upcoming Pickers on the wall mounted TV.
The senior greets them all as old friends, inquires about the dog, the niece, the newly remodeled kitchen, then quickly rehashes the history of the present illness and runs through the plan for the day. Everyone nods like it’s old hat. Because, for them, it is.
“So, if gets to the point that you need to be intubated again, we will do that, with your permission, of course.”
The patient nods incredulously.
“Well, of course,” his breathy words ring out.
“OK, very good, we always like to get your permission…And now there is something we really need to discuss. We’ve discussed it before, but it’s important that I bring it up again.”
The patient’s eyes narrow, becoming fierce in spite of their sickly, glassy appearance. His 90-pound frame tenses as much as his advanced cachexia will allow.
“We know it’s very possible that this time or sometime very soon something may happen so that you will not be able to make your wishes known. It’s important that you consider either putting down on paper what you would like to happen in this situation, or legally appointing someone who knows your wishes to speak for you. We call these documents the advanced directive and the legal health care power of attorney. They are ways for you to help guide your healthcare at a time you cannot communicate your wishes to us.”
Wife and brother’s eyes are now as wide as saucers. They stare at the senior in blank surprise. Mr. Jones is glaring in the general direction of the door.
The senior takes a step back.
“Mr. Jones, I believe your pulmonologist is Dr. Lungs. What has she told you about your condition?”
Mr. Jones tears the mask from his face.
“Now is not the time!” he whisper screams, pointing with a trembling, claw-like finger toward the door.
He grasps the mask stubbornly in his lap until we have exited, then replaces it and struggles for breath, gulping the oxygen into his hungry, dying lungs, eyes squeezed shut with effort.
Wife opens her Cosmo again. Brother changes the channel.