What I learned about patients' relationships

June 6, 2008

Sometimes it's too easy to forget what loved ones mean to us. Here's what reminded this doctor.

"She probably won't make it through the night," the ED physician said. "You'd better talk to the husband about a DNR."

It was Friday evening and I was heading home when the emergency room phoned me. An 80-year-old woman with advanced colon cancer was being admitted to the ICU in acute respiratory distress. I called my wife and informed her that I'd be late, then reluctantly headed for the hospital.

After a quick physical exam and review of the labs and X-rays, I knew the patient was dying. I looked at her husband, an old man with a deeply wrinkled face and a back so badly bent that he had to crane his neck to look straight ahead. I led him to the small conference room next to the ICU, accompanied by a social worker. As we walked the few feet to the room, I noticed the man's shuffling gait, which obviously caused him excruciating pain with each step. We sat down, and I began explaining his wife's prognosis.

"Your wife is gravely ill, sir, with terminal cancer plus pneumonia and septicemia," I responded. "I think it would be futile to intubate her and put her on a ventilator or give her CPR. It would only prolong her agony. Please consider supportive and comfort care only."

"Would you say the same if she were your mother or wife?" he asked.

"Absolutely," I said, with apparent conviction, though my response sounded insincere even to me. I really didn't know how I would react in a similar situation.

"I want you to do everything," he said. "I want her to live, even if only for a few more days. I can't live without her."

My heart sank. Meetings like this usually ended with the family agreeing with my assessment and recommendations. I felt a little angry with the old man. Obviously he knew how ill his wife was and how futile aggressive treatments would be, and yet he wanted to put her through the pain of intubation, chest compressions, and electric shocks. How unreasonable could he be?

Though my heart wasn't in it, I had to follow his wishes. I called the respiratory therapist, got arterial blood gases, and ended up intubating the patient and putting her on a ventilator. I then ordered chest X-rays, called a pulmonologist, and sat in the ICU until the patient's condition stabilized.

As I drove home through the empty streets late that night, the image of the elderly man sitting by his wife's bed-holding her hand while tears streamed down his face-stayed with me. Back home, the house was dark and everyone had gone to bed. I quietly picked up a pillow and blanket, and headed to the living room couch. At least my wife would get a good night's rest. As I lay on the couch tossing and turning, the image of the old man haunted me.