...That She Might NotDie Alone

During one of my rotations in internship at Passavant Memorial  Hopital (Northwestern Memorial Hospital) I met a patient who was dying from kidney failure. She was very weak and kindly and plain looking though she combed her hair each day. She had been an English teacher and as best I could tell had few if any visitors. It is not common to meet educated people let alone educators who maintain an interest in the arts or literature or in learning. As I got to know her I felt a kindred attachment to her and of an evening when I was on call or if I were off at a decent hour I would go to her room to talk and to bring her some poetry which I would read to her. She was much more  educated in poetry than I and she would close her eyes as I would read  until the intervals of her breathing would lengthen and at last I felt she could relax into what appeared to be a restful sleep. Ultimately she became comatose and was transferred to the ICU (intensive care unit) where I would visit her every day. Somehow I became enmeshed in a debate with the staff doctor who was the head of the ICU. I felt it was undignified to keep her on artificial ventilation when this would not be her choice for how to end her final days of "life". Regardless of how he explained to me that the definition of life was dictated by the presence of electrical activity on an electroencephalogram (EEG) and that until it ceased to exist the plug (literally) could not be pulled on the ventilator. I had since been transferred to another unit but I returned daily to visit "my patient" who had long since become a cause de celeb for me and a very emotional commitment to protecting her dignity and her peace. Still I never saw her have a visitor so that I became a mourner of one on her behalf. Some weeks later I received a page to go to the ICU where upon my arrival I found the chief medical officer of the ICU waiting to greet me. The time has come, he said. To what I replied. The EEG electrical activity is flat and it is time to pull the plug...the plug from the ventilator. I have chosen to have you do it. You have campaigned for this moment and it is only fitting that you carry out the order. With some trepidation Iwalked over to the outlet to which the ventilator was attached and reached down to pull the plug. That is where my story ends. To this date I never pulled the plug. I grasped the handle only to be overcome by tears and grief. Now you understand why we do not pull a plug until all activity of life form exist said the chief. Now you appreciate some of the difference between life and death. It is not possible to be dispassionate about life or death unless you detach from the discussion. It is not possible to love and to treat death with indifference as if it were a calculable decision based on machine calculations. Beware the trap of befriending your patient. The passion and the pain of loss becomes part of the relationship too.

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