A Scary Prognosis
I had dropped Mom off earlier at St. Luke’s Roosevelt in New York. She had an appointment for an outpatient, post-mastectomy procedure. Why did her doctor now want her to stay overnight?
“You need to get down there and find out what's going on,” Dad said.
He couldn’t join me; he had just had his ailing gall bladder removed the day before.
“I'm so upset right now. I want to be with her,” he said.
“I know. You're in no shape. She understands,” I tried to reassure him.
St. Luke’s ambulatory surgery staff led me to Mom. When I saw her, I almost cried.
She lay asleep. A long plastic tube stuck out of her mouth. A long clear hose connected that tube to a ventilator. The staff had secured the breathing tube in her throat so that her lips wrapped around it. Her languid face looked disturbed.
My mother was on a respirator! My grandmother had withered away on one many years before, while dying of emphysema. Granny had begged Mom to take her off it. Those were the days before healthcare proxies, when doctors’ decisions were final. Only a court order could overrule them.
My mother never wanted to be on a respirator!
Dr. Murray approached me. He looked more like a college shooting guard then an associate surgeon. His assessment left a knot in my gut.
“She stopped breathing when we extracted the breathing tube after the surgery. We reinserted it, but she didn't take to it well. We had to put her on the ventilator so she could breathe,” he explained.
Somehow, Mom’s emphysema had coated her lungs with fluid; she was literally drowning. The anesthesiologists needed to ventilate her while they treated her lungs. Sedation was standard procedure.
“Will she definitely come off the respirator?”
“We believe so,” Dr. Murray replied.
“Are you saying that she might not come off the respirator? She might not be able to breathe on her own?”
My heart jumped into my throat. I stood face-to-face with my mother's death. Her healthcare proxy declared that she did not want any artificial resuscitation if she had no hope of recovery. I might have to order her removal from the respirator.
How could I do it?
Turning the Corner
An anesthesiologist arrived later. He offered a better prognosis, believing that Mom would come off the respirator later in the day. “What she has is not that common, but it's not that uncommon, either,” he said.
Another anesthesiologist, a middle-aged woman from France, came after that. She explained that Mom’s smoking had irritated her lungs and caused the fluid build-up. “She said she'd dropped down to half a pack a day,” the anesthesiologist explained.
“Wait. You mean she's smoking?”
Mom and Dad had quit together two years ago. At least, I thought that she'd quit.
The truth now hit me like brickbat. My mother had a ventilator in her mouth and a breathing tube down her throat. All because she continued a deadly habit that she'd convinced the rest of us she had given up.
I left to call home.
Mom woke up after I returned. She signaled me to take the respirator out. I explained why she needed it. She shook her head and then signaled for paper and pen. I gave her some paper and a pencil. Mom then wrote:
I want it out. I want to go home. It's my right.
She demanded that I kill her when she had hope! I stared at her and said, “If they remove the ventilator before you can breathe, you'll die. Do you want your grandson to see you in a box? Don't you want him to remember you?”
The fight faded from her eyes. She soon fell asleep again.
I went to the waiting room afterwards. There, I read an article in Time about “Mary and the Protestants.” When I read an account of a scene in the Passion of The Christ, in which Mary ran and comforted the fallen and crying young Jesus, I had to stop. I wiped a tear from my eye. My mother needed my strength, not my fear of losing her. That meant I needed someone else.
I prayed for Mary's intercession for my mother. I asked her to ask Jesus to heal Mom.
A nurse called me an hour and a half later. I rushed in and saw Mom’s face minus the throat tube! The anesthesiologist had removed her from the respirator. She smiled as she saw me.
“I told you I wouldn't let them leave you like that,” I said.
By 7:00PM, she had turned the corner. The overnight stay would just be for observation and prevention of a relapse. She breathed on her own by then. Meanwhile, the staff had her quite comfortable in recovery. I kissed her goodbye and left.
The next day, I took her home.
Mary answered my cry. The Great Physician made His own house call through the efforts of my mother’s medical team. May God in His infinite glory be praised! We thought we lost Mom. He found her.
Comments from a Catholic Nurse
This is a lovely story and the point about being strong for the people we love is great! Along with love and strength we need accurate information, which is becoming harder and harder to get as the push toward euthanasia grows stronger in this country.
Many people are totally confused about ventilators and automatically check vents off in advance directives as an unwanted treatment. I consider this to be a big mistake for many reasons. As an ICU nurse, I work a lot with vents. It's usually the last resort when a patient has severe breathing problems. Much, if not most of the time when someone becomes severely short of breath, we are unsure as to the cause. Using a vent can buy time to ascertain and perhaps cure the underlying problem. Sometimes being on a vent can act like a cast to allow the lungs to heal with the least stress. The new high-frequency vents in babies can allow their lungs to mature or heal and this has saved many newborns and preemies who would have died just a few years ago.
Unfortunately, people have been so brainwashed about vents that I run into many people who think that vents are permanent, vents mean a person is automatically brain-damaged, vents can keep a person alive forever, etc. Vents are one of the first things to be checked off as not wanted on a “living will” or DPA form. (A durable power of attorney for health care document, “DPA,” appoints a specific person a “surrogate” to make decisions about your care if you are incapacitated.)
Actually, most people are able to get off vents in a short time and most people are sedated while on the vent so that they are comfortable. Some people with permanent neurological or other injury (think Christopher Reeve) need a vent continuously and adjust quite well over time. Many disabled people are on vents at intervals, often just at night.
The bottom line is that any treatment can be withdrawn if truly futile or excessively burdensome to the patient. It is not necessary for a patient to refuse potentially life-saving treatment with a ventilator in advance from fear of being forced to live “on a machine.” For example, when a patient is dying from something like lung cancer, we don't have to use a vent, but rather we use medication and oxygen to make the patient more comfortable.
One problem I have personally run into is the “terminal wean,” when a patient is judged “hopeless” quite quickly, sedation or pain meds are increased and the patient is suddenly taken off the vent with the expectation even the hope that the patient will not resume breathing.
On a personal note, one of my daughters was on a vent when she was a baby and when she developed severe respiratory problems while awaiting open-heart surgery. When it seemed that she probably wouldn't survive, I did allow a DNR order. One young resident “offered” to remove the vent because she was “hopeless.” I was furious. I reported the resident and he was almost fired, but this was 1983, not 2002.
This New England Journal of Medicine article reveals how subjective the decisions of physicians often are regarding patients' future functional status and cognitive function when they decide to withdraw vents. Most patients in this study were able to be weaned from the ventilator if it was not prematurely withdrawn. And, contrary to many people's perception that people can be kept alive indefinitely by “machines,” some patients died even while on a ventilator. This information is not routinely given to people who sign “living wills” and other advance directives, and most people just check off ventilators as treatment they do not want without knowing all the facts. Unfortunately, families encouraged to consider non-heart-beating organ donation are also often unaware of these facts.
© Copyright 2005 Catholic Exchange
Frank J. Tassone II is a Catholic revert and blogger. He writes from Montebello, New York, and works in New York City as a High School Special Education Teacher.
Nancy Valko, a registered nurse, is president of Missouri Nurses for Life, a spokesperson for the National Association of Pro-life Nurses and a Voices contributing editor.