She went into a fast cardiac rhythm, and I was asked to consult for her cardiac status.  When I walked into the room, at first glance I could see that the woman was in a perilous condition.  Her heart rate was over 140 beats a minute (normal is 60-90).  She was breathing very rapidly.  Her oxygen saturation (a measure of her ability to maintain a safe level of oxygen carrying ability) was dramatically low.   I started some medications that over the course of a few hours were able to lower her heart rate to about 110 (acceptable but not ideal). 

I saw her again 2 hours later.  Even though her heart rate was better, her respiratory status and kidney function was not improved.  It was clear that a decision would need to be made about putting her on a ventilator (a machine that would keep her alive, artificially). She would also need kidney dialysis, taking off her blood, to reduce the congestive heart failure that was developing. 

So here was an elderly woman, over 80 years old with an overwhelming infection, kidney failure, respiratory failure, congestive heart failure, septic shock, questionable mental status, and a rapid heart rate.  In addition she had hypertension, diabetes, and severe obesity.

Due to the multitude of medical problems, the likelihood of her recovering and living meaningful life was extremely low- perhaps one in 100, probably less than a 5% chance of living.

Placing her on a ventilator and performing dialysis would likely keep her alive- for a while.  Yet, her chances were grim.  She had already been in the hospital 36 hours and was still in critical condition. 

The question was:  what should be done?

A went out to talk to the family regarding her condition.  The room was full of very concerned people.  Her husband, three daughters, a son, and seven grandchildren of various ages were worriedly waiting outside.  I spent about 20 minutes explaining what I thought was a very thorny decision that had to be made.  Should she be put on a ventilator, kept alive artificially?  Should we proceed with dialysis?  Without these two treatments she would surely pass away.

Now, no discussion of the medical costs ever came up.  What would be the cost to the medical system- Medicare, and Blue Cross if she was put on artificial machines and kept alive?  No one can predict how long she might live:  a day, a week, or even six weeks.  She might even live for years (I’ve been involved with a similar patient who lived 6 years after just such an event).  Since her mental function had not improved she could overcome the infection, never regain normal function, yet live many years on a ventilator.  She might need permanent dialysis ($25-$50,000/ year).  The total cost could of her care could run $100,000 to perhaps over 1 million dollars.  The ICU costs alone could be $50,000-100,000. 

Now of course, no price tag can be put on a human life.  And I am not making any suggestions as to what should be the proper course of action here.