A Tale of two Families

Two patients with two very different families impacted my life this week.

One patient was an old lady with dementia who wandered into rush-hour traffic and was struck by a car, leaving her with a very severe brain injury. During the course of her hospital stay, she acquired a pneumonia and her neurologic status never improved. From the very beginning, her family was in the room with her. Generations of visitors came, from small children to the elderly. Whenever I walked by the room, someone was holding her hand or sitting by her side despite the fact that she was completely unresponsive. The family asked a lot of questions and wanted to be involved in her care. When it came time to discuss withdrawing care from her, the family came together and made a very difficult, yet mature and humane decision to remove ventilator support and allow her to pass away knowing that she would never recover in any meaningful way. After her ventilator was turned off, the family sat in the room with her. I saw tears streaming down their faces. It was obvious that they loved this woman deeply. She quickly and painlessly passed away. Afterwards, the family expressed their gratitude to us for our efforts.

The other patient was also an elderly man. One day he was driving in his car and was involved in an accident. When he arrived at the hospital, we realized that he had suffered large strokes on both sides of his brain. He would never recover. Over the next few days, I never saw a family member in the room with him. Nobody came to hold his hand. Nobody came to pay their respects to their brother, father, friend, or grandfather. We finally tracked down the family, and a few people showed up. Their visits to his room were brief, and it was obvious that they considered his illness more of a burden on them than it was on him. One family member even expressed her dismay about a family meeting we had scheduled in the afternoon because her car did not have air conditioning and she did not want to have to drive in the midday heat. When we discussed withdrawing support, the family member with the power of attorney was not willing to do so until she could make sure that she would get his property after he died. We asked them to look into burial options, and the family wanted the hospital to pay for it. Ultimately, the family member with the power of attorney told us that she would call us after the weekend to tell us whether we should withdraw support or not. Monday came and almost went, so we called her. She was very nonchalant on the phone and said, "Yeah, go ahead and do it." When asked if she or any other family wanted to be there when he died, she said no. So today we disconnected his ventilator and kept him comfortable. I stood at the door of his room and watched a lonely old man taking his last breathes alone in a cold, sterile room. No tears were shed at his bedside. No last respects were paid.

Although both of these patients had no hope of recovery, and the ethically correct choice to allow each of them to pass away was ultimately made by both families, the contrast in how it was handled was striking. I could not help but feel a tremendous sense of sorrow for the second patient who did not pass away surrounded by a loving family. Had he been a bad man? Were his family members selfish and shallow people? Or were they good people who were unprepared emotionally to cope with death and dying?