An ancient tenet of medical practitioners is, “First do no harm.” Though widely embraced, it’s not always applied in today’s medicine. Surely such ethics should extend beyond healing and dictate a compassionate ending.
My brother, Jimmy, died around 7:15 pm on Monday, July 25, 2022. I understand why, but I’m troubled by how. Whether it was poor procedures, legal issues, or profit motives, I can’t say. I just know it was wrong.
A massive heart attack around six a.m. on Saturday, July 23rd caused his heart to stop beating. He was shocked then connected to an impella, ventilator, and a barrage of IVs. Jimmy had been hospitalized, except for a brief stay in rehab, since June 13th. He was exhausted physically and emotionally.
His bladder function had been increasingly problematic since March 14th when he fell at home due to a diabetic episode and couldn’t get up. He had tolerated the discomfort of a catheter almost constantly since May 12th.
On July 20th he had emergency surgery for a severely distended abdomen. The surgeon removed two sections of dying colon tissue and performed an ileostomy, leaving him with a bag we hoped was temporary.
The day before his heart attack he sat in a recliner in the ICU for a couple of hours. It was the first time he’d been upright in over two weeks. Saturday’s plan was to walk a few steps but his heart had other ideas.
At best Jimmy was facing a foreboding future with major health issues. He asked me twice, while in the hospital, about a living will. He had asked before but I had procrastinated. From his room I did some online research and found Georgia has a standardized Advanced Directive. But it’s 28 pages, too much to discuss I thought.
So, I’m partly to blame for what I consider inhumane treatment. Shocking him was not the merciful thing to do, but what followed was worse. Regardless of my failure, Jimmy suffered needlessly for two additional days.
An impella, I learned, is a tiny propeller inside a stent that’s placed in the heart via the groin and connects to an exterior pump. Jimmy’s impella was doing about 90 percent of the heart’s work. It’s a temporary device for hospital use only. You can’t take it home.
My bigger concern, however, was the ventilator, not that it was initially employed but that it took two days to have it removed. On Saturday Jimmy couldn’t talk due to several tubes down his throat, but he was alert. Padded mittens on each hand prevented him from pulling the vent out.
For hours he motioned repeatedly to remove it. With medical staff present, I made sure he understood he probably wouldn’t survive without the vent. When I asked if he still wanted it removed, he nodded and clearly affirmed he did.
A nurse, however, told him they really wanted him to try it another 10 or 12 hours. She said additional medication could make him comfortable, so he agreed to the overnight trial.
I spent the night by his bed, but Sunday morning couldn’t get anyone to discuss removal of the vent. They said my request would be made known, and someone would come to discuss the situation. I continued to inquire but no one came.
A second night passed and Monday morning was more of the same. Everyone said they would pass my request along, but at four p.m. no one had come. By then Jimmy could no longer move his fingers or toes and his eyes remained closed.
My wife saw a door with a DIRECTOR’s sign and found an angel wearing a uniform. I told her if there was a possibility of Jimmy improving we wanted to do everything possible, but otherwise he’d been through enough. She was unaware of our dilemma and lovingly attended to my brother. He was disconnected and lived over two hours, long enough to smile briefly at our mother and try to say, “I love you.”
I don’t blame the hospital for Jimmy’s death, but I do fault them for prolonging his suffering. The wishes of a patient with no hope for an acceptable quality of life shouldn’t be circumvented by artificial means. And if the patient agrees to a short trial, the terms should be honored.
It’s unlikely the musings of a small town columnist will bring about change, but I believe the focus of today’s medicine is frequently misdirected. We keep people breathing without considering if it’s the compassionate path. Today’s medicine often fails to practice what has long been accepted as the gold standard of care. “First, do no harm.”