But what happens when we, the medical establishment, declare hope for recovery is finally lost and the healthcare team no longer wants to keep someone in suspended animation? This is when, at our best, we fumble around in the dark. And at our worst, well …
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“The time for removal of life support is set. The date and time are not negotiable.”
Had it been October 31 I might have believed the shadow of the scythe hovered too near the nurse practitioner as she spoke these words. On any other day, likely on the day Mr. Matthews first entered the ICU, angel wings would have filled the halls as heroic efforts were made to save this man’s life. We move so quickly and think even more deeply as to what can possibly be done to cure someone; yet we often fail to pause amid the avalanche to anticipate and prepare for what might need to happen if our efforts fail and death comes lurking despite all efforts to forestall the feared Grim Reaper's visit. In Mr. Matthews' case, the ICU team has decided the time has come to bid him farewell.
An infection ravaging his body has created a wound so deep you can see the pink of his lungs as they expand and contract with each breath forced by the ventilator keeping him alive.
"His wound will never close," his team declares. It is equally clear that his lungs will never be free of the breathing machine, which means he is tethered to ICU bed 12 until he dies. And when tireless machines are maintaining life, that can be nearly indefinitely. Or ... at some pivotal, often mystifying moment, when the medical team deems all further curative care futile, making the withdrawal of life-sustaining care necessary. In the case of Mr. Matthews, that action will result in this husband and father dying within moments.
For the ICU medical team, that is all in a day's work.
We have developed protocols with stepwise procedures to remove people from life-support machines. Before we turn off the ventilator, we escalate pain medications to ensure the patient doesn’t feel discomfort or distress. Monitors are turned off, and fewer team members visit. In the silence of the new-found calm, the endotracheal tube is removed, and loved ones gather and wait for the last breath to be exhaled.
For people like Mr. Matthews, whose level of consciousness can be difficult to discern, we will never really know what this experience is like, if he is aware, in pain, afraid, or perhaps, relieved.
The same cannot be said of his 20-year-old daughter, Leah. She is wide awake at the bedside of her father nearly every moment of every day except during the times she reluctantly naps in a closet-turned-apartment just off to the side of the ICU waiting room.
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