Grandma Is Toast

One hundred or even fifty years ago, no one would dream of sending their 85 year old mother to the ICU to die. When my grandmother was dying, my mother sat at her bedside and held her hand until she passed away. I doubt it occurred to her to call an ambulance and transport her to the hospital . She was very old and it was her time. Why die surrounded by strangers sticking you with needles and shoving tubes in various places, when you can die in your own bed, surrounded by your loved ones?

For reasons that escape me, modern Americans seem to have forgotten the natural cycles of life. We are born, we grow old, we get sick and we die. It always astounds me when I go into the waiting room and inform a gathered family that their 87 year old matriarch is dying, and they are shocked and stunned by the news, demanding to know what can be done to save her. Can we operate? What about dialysis? Start the tube feedings and put her on the ventilator!

I sometimes feel like asking them "How long did you expect her to live? A hundred? A hundred and twenty?" It seems we have lost touch with the fact that despite the advances and power of modern critical care medicine, people are not immortal. People grow old and then they die. Each and every one. No one is immortal. While I tend to remember the young, salvageable patients that I save, these are actually somewhat rare. About 80% of what we do in the ICU is help ease the transition from this life to the next.

It is amazing to me how often I get the late night calls from the ER with some 9,000 year old guy from the nursing home with respiratory failure, hypotension, wildly abnormal blood chemistries. The ER doc will proceed with some prolonged presentation of the case, and the whole time I'm thinking "Call the priest for the love of God! There's nothing I can do for this one." They need the Angel, not me. But I have long since stopped fighting that particular battle. If they want me to buy them a few more hours of life, even if it involves painful procedures, needle sticks, various intubations, I come in and do it.

But I can't help but long for a more rational society where our old ones are kept at home to die. How much nicer would it be for the patient when instead of me shoving needles into central veins and tubes into tracheas, their loved ones made them tea, and talked about their lives, joys, memories. Talked and kept them company as they passed from this life to the next.

Instead they often come screaming into the ER and are transported directly to the ICU. Once their I go to work on them, suppressing my feelings about the obvious futility of what we're doing. I don't mind the actual work, the worst thing is:

The Family Meeting!