after a long illness, with a feeding tube and a
tracheostomy,andshehadmentionedthatshedidn’twant
todiethatway.Butherchildrencouldn’tlethergoand
askedtoproceedwiththeplacementofvariousdevices:a
permanenttracheostomy,afeedingtube,and adialysis
catheter.Sonowshejustlaytheretetheredtoherpumps,
drifting in and out of consciousness.
Almostallthesepatientshadknown,forsometime,that
theyhadaterminalcondition.Yetthey—alongwiththeir
families and doctors—were unprepared for the final
stage.
“We are having more conversation now about what
patientswantfortheendoftheirlife,byfar,thanthey
havehadinalltheirlivestothispoint,”myfriendsaid.
“The problem is that’s way too late.”
In 2008, the national Coping with Cancer project
published a study showing that terminally ill cancer
patientswhowereputonamechanicalventilator,given
electrical defibrillation or chest compressions, or
admitted,neardeath,tointensivecarehadasubstantially
worsequalityoflifein theirlastweekthanthosewho
received no such interventions. And, six months after
theirdeath,theircaregiverswerethreetimesaslikelyto
suffermajordepression.Spendingone’sfinaldaysinan
ICUbecauseofterminalillnessisformostpeopleakind
of failure.You lieattached to aventilator, yourevery
organshuttingdown,yourmindteeteringondeliriumand
permanentlybeyondrealizingthatyouwillneverleave
thisborrowed,fluorescentplace.Theendcomeswithno
chanceforyouto havesaidgood-byeor“It’sokay”or
“I’m sorry” or “I love you.”