She was sitting in the corner reading her bible.
We shuffled in, all of us, and because our resident told us that she was afraid of infection, we all made a show of scrubbing our hands with antiseptic lotion before even entering the room.
He was lying there, intubated. He would cough occasionally, the alarms on the respirator would go off occasionally, and then he would settle back down. He had a few IVs, and the site of the tube was in through the front of his neck. She didn’t want us to touch him out of fear that he wouldn’t be able to fight his infection any longer. Out of fear that he might die prematurely.
He already had.
About 8 years prior, he was a vibrant young man. He was popular. He was also into drugs. And about 8 years ago, almost to the date he overdosed. He slipped into respiratory arrest first, his brain no longer interested in breathing. Almost as if he’d forgotten how to breathe. From there he slipped into cardiac arrest before it was discovered that he’d overdosed. He’d been in cardiac arrest for a short time – 5 to 8 minutes before he was discovered and before CPR was started.
He recovered a rhythm on the way to the hospital. He was later able to breathe on his own. He hasn’t walked or talked since that day. He lives in a nursing home nowadays where they feed him pureed food because he cannot chew. He cannot write or use either of his hands. They rest near his clavicles because of the spasticity that his massive brain damage caused. He has no meaningful motor function. He also does not respond to verbal questions or commands. He cannot make eye contact, nor can he even control which direction his eyes point . About the only things he can do are breathe and swallow.
A few days ago he was discovered coughing wildly, and sweating profusely. His caretaker got him admitted to the hospital where he was put on a trial of antibiotics and eventually intubated and put on a respirator for a florid case of pneumonia. As the infection finally started to clear up, his doctors tried to wean him off of the respirator. It didn’t work. So they moved his intubation site to his neck, to alleviate the stress on his respiratory system of having all of the oral secretions make their way down (apparently you make 1 liter of saliva every day).
So now he lies there, helpless, unproductive, comfortable.
And it made me angry.
It made me angry that he had figuratively blown his brains out. Insurance is what pays for his nursing home care. Those costs are passed onto me in the form of higher premiums. It made me angry that because he is in the position he is, friends of mine at the opposite end of the spectrum are unable to afford medical care. You see, some of his care is charity care – but the fact remains that there are others who have problems that I feel more sympathetic to.
I was angry that I felt like I could judge the value and quality of his “life” in such black and white terms. It didn’t seem gray to me at all – he’d done it to himself, and now he was stuck in a place where he wasn’t at all able to help society in any manner. 150 years ago we thought that black people were 3/5ths human beings. What are we wrong about today? Consciousness?
I found myself confused. I found myself angry and hoping that our patient was somehow getting more out of the encounter than he appeared to be. I was hoping that he had some form of consciousness that was overall a positive experience. I was hoping that he was perhaps in a state of consciousness similar to the one that neonates are when they are in the womb, or immediately after birth. Part of me hoped that he was still high – floating blissfully through the rest of his state and society sponsored life.
I just hoped that it was worth it. I couldn’t reconcile what would be better or worse – to allow his physical body to pass on, and utilize the resources for people who are alive and awake who can continue to exchange with the rest of the world – OR to let him lie there comfortable until the time when he does finally die and use those much needed resources to help this young man.
He was a young man when he died – only 21. He’s now 29.
The person who made the decision to keep him from passing away is his mother. She would have no talk of “allowing nature to take its’ course” when the pneumonia made a respirator the only course of action capable of keeping him alive physically. Deeply religious, she sat quietly, clutching her rosary beads, reading her bible the entire time we were there. Our resident told us that she’s been praying for twenty minutes every hour every day to make sure he doesn’t die.
All I could think was: Ma’am, he’s already dead.
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