In a darkened intensive care room, the struggle for life was taking place. All sorts of life sustaining chemicals were being dripped from an IV pole into the limp body. A gurgling sound emitted from the sick lungs trying to deliver oxygen to the other organ systems. All the systems were struggling after 87 years of life. At what point is someone allowed to die comfortably?
Doctors and hospitals do a great job keeping someone alive against all odds because death has never been an acceptable endpoint. Yet, death is an end that all life meets. At some point, the end of life must be embraced. At some point, doctors and family members must let go and embrace a concept called "comfort care only."
"Comfort Care Only" is an actual medical order that can be enacted by a physician. The specifics of such an order clear the path that allows a patient to die comfortably without hindrance. What entails "comfort care?" Three simple tasks keep a dying patient comfortable: bowel care, bladder care, and pain control. That's it; no food, no hydration, no antibiotics. Bowel care means that the excrement in the digestive track is kept moving and is evacuated. Any impactions are cleared. Anyone who has been constipated understands how uncomfortable a bowel blockage can be. Bladder care means that the bladder is kept empty and the urine is allowed to flow unobstructed. An uncomfortable, distended bladder is avoided. Finally, a comfort care order provides for aggressive pain control by whatever means necessary. With a "comfort care" order, the goal is not to keep someone alive; the goal is to provide as much comfort as possible in the impending death of a patient.
My 87 year old grandfather was that limp body in the darkened ICU room. Even though he had multi-system organ failure, his doctors refused to honor the family wishes for comfort care only. Usually family members are not so intent on directing patient care. Usually, family members do not include a doctor like me. My grandfather, a navy veteran of World War II, was in pain and suffering at the end of his life. The system only cared about keeping him alive because to them death was unacceptable and bad for the bottom-line of the hospital finances. Unfortunately, this was at a time when the Physicians Orders for Life Sustaining Treatment (POLST) law in California was not yet in effect. If the PLOST had been in effect and legally binding, I would have been able to cut through the hospital red tape and override the other doctors. The only pathway that would allow my grandfather to die comfortably was to appear before the hospital ethics committee.
Every hospital has one. This group included nurses, doctors, community members, and hospital administrators. I put my heart on the table and won the right for my grandfather to die comfortably. He died peacefully in a warm comfortable room devoid of machines and noise. He died in his own clothes with dignity. And per his final wishes, he is buried in the National Cemetery in Arlington.
I share my story because I hope that no one has to go through the same scenario that happened to me, my family, and my grandfather. Please educate yourself about your rights in life and in death. And make your wishes known.
Published On: February 26, 2010