As a geriatrician, it was still difficult to facilitate compasstionate patient-centered end-of-life care for my grandmother. Honoring patients' goals of care can be challenging when we are intimately invested.
“It’s Moe,” my mother gasped through tears, speaking of my grandmother who I adoringly named when I was too young to pronounce her proper grandma name.
“She’s unresponsive. They’re doing CPR.”
In that moment, my world shattered. Moe was 86 years young, healthy and fully functional from my geriatrician’s perspective. Just a few days ago we had casually strolled through the aisles of the grocery store together catching up on family drama. I would have never expected this. However, as a well-trained geriatrician, I also knew that one must always expect the unexpected in this fragile stage of life.
As I raced home three hours through torrential rains brought on by an unseasonable Nor’easter, my mind turned in every direction. The granddaughter in me was struggling to suppress the “miracle” thoughts. Forgotten was the data that octogenarians have less than a 3% chance of walking out of the hospital after a cardiac arrest. She must be the one patient who is going to beat this. She’s so strong. This isn’t her time. However, the geriatrician in me knew that this was the beginning of the end of her life.
Moe and I spoke every night on my drive home from work. She would always ask, “How are your patients doing? Are any of them sick today?”
She was so proud of me. That I was caring for “old folks” like her. She would often remind me, “When it’s my time, you let me go. Don’t ever let me suffer.”
She took comfort in knowing that I would be her personal geriatrician when and if she ever needed me. She trusted that I would help facilitate compassionate, patient-centered care for her when the time came.
As the doors of the sterile emergency room trauma bay opened, there she lay. Pale, still, unrecognizable. But alive. It was our worst nightmare; hers and mine. She survived the code that should have never happened. She was DNR. Now intubated, sedated, tubes and lines coming from every orifice. In one sentence, the stoic physician caring for her said every medical acronym I knew: ROSC, UTI, CAP, ARDS, ATN. It was worse than I had imagined.
She was quickly transferred to the Intensive Care Unit where I was silently praying someone would address the elephant in the room. She was clearly dying.
It was now up to me to muster up the courage to ensure that she died on her terms. A “good death” as we often call it. We compassionately extubated her that evening with dignity and surrounded by loving family.