Wednesday, June 30, 2004


Patient C was a world traveler. She and her husband of 56 years have traveled through every continent except Antarctica, have hiked the Great Wall of China, weathered a hurricane in Singapore, flew over Kenya in a 3 person airplane, guided a boat through a river in the Brazilian Amazon, and toured East Germany before it became united. And these are just the stories that I've heard from the husband in the short time that I've known them. They have several children, each born in a different country, and many grandchildren. They live in a house that they built with the money earned from running her husband's veterinary clinic. And their current garden is the envy of the neighborhood.

But none of this matters now. Because right now, Patient C is gasping for breath. Patient C is nothing but a little old woman, slowly losing consciousness and her grasp on life as her carbon dioxide levels climb higher and higher. Jaundiced, emaciated, scarred, and edematous, she looks like a sick scientist's experiment. There are yards of clear plastic tubing and drains and IV's going into her and coming out of her. Her legs, showing signs of early gangrene, are covered with dressings that soak through from her weeping blisters. She is connected to machines and state-of-the-art electronics that can do nothing more for her right now other than to alert me that she is quickly dying.

A few minutes ago, I think she told me that she will accept a ventilator. But I'm not sure. Her living will located prominently on the front of her hospital chart dictates that artifical life sustaining measures are not to be taken. But this living will can be nullified by the signee at any time, and I think she agreed to an artificial ventilator as she was losing consciousness. But I'm not sure.

Just one word is all it takes for me to give the order to intubate this woman and save her life. But just one word is also all it takes for me to violate her rights, and her wishes.

"Mr. C, what do you want me to do?"

Because of the discrepancy between the living will and what I think the patient said, I have to defer to the husband. He too, is not sure what she said before losing consciousness.

Mr. C gazes at his dying wife. He looks at me with his heavy, burdened eyes. His shoulders, heavy with the pain, begin to shake, and his eyes, red and sunken from many sleepless nights spent next to her bed, look at me searching for answers.

"Doctor, what should I do?" he asks, softly.

"I don't know..." I replied, just as softly, and held his shaking hand.