Here are my last wishes

Based on my own experiences with end of life care, I have discussed the following with my wife, who would be in charge of making decisions for me should I become incapable of such. I think it's important that every human adult have a similar discussion with someone to assure you don't end up a vegetable in the care of the government.

At this point in my life when I am relatively healthy, I do not want to be a DNR. If I stopped breathing, or if my heart were to stop, I'd like medical workers to do whatever they had to do to try to save my life. I call for this mainly because I value life and love life.

However, if I arrive in the hospital after CPR has been done on me for a half hour and my face is STILL blue by this time, just let me go. If you think I'm gonna not be me when I wake up, just do the humane thing and let me go.

I do not mind if I have to be on a ventilator for a few days in order to give medical professionals the opportunity to rest my body and treat the underlying cause of my problem. Yet if whatever caused me to be on a vent is terminal, then after a few days just pull the plug. Considering I have asthma, I do not want to suffocate.

Oh, and that's the next area of discussion. I do not want to suffocate at the end of my life. If I appear to you as a fish out of water, then give me all the oxygen I want and sedate me to the point I'm comfortable. Don't let me drown. Don't let me suffer in pain.

Also, if I so happen to by a CO2 retainer, and I need oxygen, make the doctor give me oxygen. Don't let the doctor deprive me of the main source needed to maintain life. Don't make him let me suffocate because of the hypoxic drive hoax.

If I have a chronic disease and am chronically addicted to pain killers or alcohol or other drugs as a result, don't allow a doctor to set me in a hospital bed and allow me to go through detox. Have him solve my underlying problem and then he can deal with the addiction. So make him give me some kind of sedative.

Now, if I have a CO2 greater than 80 (like say 190), again, don't let my doctor withhold sedatives because he's afraid my breathing will slow down and my CO2 will rise. Don't make me suffer this way.

This is especially true if I'm awake and fighting the RT and the RN and the DRs efforts to treat me. Say, for example, the doctor order is for me to be on BiPAP, and I keep refusing to keep the BiPAP mask on (which I can see myself doing), don't allow the nurse to hold my hands down while the RT forcibly puts the mask back on my face.

Please, if this is the case, just let me have my way.

Look, I don't mind if I need to be on a ventilator to get over the hump, and I don't think I even would mind being ventilator dependent so long as my brain is fully in tact. Yet I do not want either of the above if my brain is not intact.

In summary, if I'm blue oxygenate me. If I'm still blue, ventilate me. If I'm still blue, just let me go. And don't be blue yourself, because I'll be in a happier place. My time has come. And by me writing you this letter you should be at peace knowing I lived a good life and you prevented me from unduly suffering at the hands of medical professionals who have to do everything for fear of getting sued -- unless you step in.

Oh, and one more thing. Be good to the people caring for me, even if they aren't friendly. Don't be sue happy just because you're angry I died (because I don't want you to be angry. I want you to be happy for me). However, in the rare chance of medical neglect, feel free to do what you need to do.

Likewise, since I will no longer be using my body, don't let my body rot for no good reason if it can be of use to help someone else live a better life in the one they currently have. Don't be afraid to donate certain parts of my body to the Gift of Life.

I know it sounds kind of disgusting, yet I believe God's underlying mission for each of us in this life is to make life better for our fellow men and women. I know I've done my part on this earth by improving the lives of many in my own way (hence my blog family and my own family). So don't be afraid to let me make one final gift to a fellow human being.

There, I think I covered all the bases. Life is good. But life without a brain is not good. I'd much rather move on to be with the Lord than to be a vegetable in this one. Capish.

Now, I don't plan on dying any time soon. Yet I write this post because I've seen some horrible things in the hospital setting. Sure I've seen many miracles and have seen more good things than I'll ever see horrible things. Yet the end of life should be peaceful, and that's how I want mine to be.

All pateints deserve equal respect

She's a 66-year old end stage COPD patient and she's highly demanding. She doesn't mean to be annoying, she's just scared. So my advice is: Give her what she wants. Spoil her. Cater to her.

But, gosh darn it, stop getting irritated with her. If she wants those darn things over her ankles that vibrate the blood through her legs to prevent blood clots, dog gonnit put them on. If she wants a glass of water, go fetch it. If she wants to be tucked in, just do it. If she wants her oxygen on 3lpm instead of 2lpm, then dog gone it just do it.

She was so upset when I entered her room. I said, "What's wrong."

"I'm mad!" She said.

"At me?"

"No. At the nurse. I wanted those things on my legs and have asked four times and she refuses. She also refused to tuck me in better, because I was highly uncomfortable. Finally I told her just to get out of my room."

"Is there anything you want me to get for you. I'll do anything you want," I said.

"No. I'm feeling pretty comfortably now," she said, and she looked it.

I understand completely how the nurse feels, because this patient is highly demanding. Then again, this lady becomes dyspneic every time she even moves in her bed. She is scared. She is dying. It just irritates me that someone wouldn't take an extra step to cater to this woman. Give her whatever she wants. Let's make her happy. Let's comfort her.

Isn't that our job? Isn't that what we're here to do? Even if it's not, I see no reason why this sweet old lady can't get what she wants, annoying or not.

Her treatments are ordered QID and Q2 prn. I see absolutely no reason why she needs a breathing treatment every hour. But she asked for one and I shall giveth. Inconvenient -- yes. The right thing to do is giveth -- absolutely.

And I shall sit in her room and visit with her because I have a feeling she likes the company. She smiles when I'm in the room, and perhaps she provides me a sense of I'm-doing-a-good-deed on an evening where I otherwise probably don't even need to be here.

Sweet lady in a confusing moment

She was out of it. When she fell into a deep sleep she went apneic and her spo2 dropped to 72%. The RN tried to awaken her, but she would not respond. And when she finally did respond, she had no clue who she was nor where.

The doctor, correctly, opted for BiPAP. I was a head of the game and already had the BiPAP ready to go. Keep in mind here this lady was completely either obtunded or out to lunch for over two and a half hours.

So, I go to put the mask on her and she wakes up and is completely defiant about putting "that damn mask on my face." She writhed her head this way and that, grasped with her hands. I had the RN hold her hands thinking she simply wasn't with it and was just reacting. But, as it turned out, she was as alert as my 3 month old in the middle of the night when you expect her to be sleeping.

I was surprised by her reaction here mainly because she was so OTL for so long. I tried to wake her up before I put the mask on, and she never even twitched. So I figured I'd put the mask on real quick and be done with it.

But, that's not how it went down. So here I'm standing watching this lady flail, and screaming how much she didn't want my BiPAP.

I was thinking, "It's amazing what a little scare with the BiPAP mask can do to a person. It can wake up a person, change her mental status."

I pulled back the BiPAP mask; no point in forcing it on someone who is fully awake and defiant. I certainly don't want to traumatize the lady any further. I don't want to be inhumane. I shut off the machine and listen to the discussion between RN and patient.

"We need to put you on the machine because you stopped breathing when you slept," the RN said.

"No I didn't," the patient said.

"Yes you did."

"No. I'm just fine."

"No you are not. You need help with your breathing."

"Well, I'm fine now."

"Yeah, you're fine now, but when you sleep you have trouble breathing."

"So, I'm fine now, so leave me alone."

"So," the RN says, "When you stop breathing again, can we put the mask on you then?"

"Only if I stop breathing for two hours again."

"Well, it doesn't work that way."

"Why not."

"We can't let you go 2 hours without braething."

"Well, I don't want that mask."

"Okay, well, if your heart stops beating, do you want us to put a tube in your throat to help you breath then."

"Why don't you try it now so I can see if I like it or not."

That's where I had to leave the room.

It was a sweet old lady and she was so cute. And she had no clue. The sad part about it is that she had no family, no person to help her make decisions. She should have been a DNR patient I thought. It should have been discussed before now. It may have been. I highly doubt even under the sanest of moments this lady may not have a clue about what we are referring to in an attempt to help her survive another day.

Or are we only seeing a lady in her weakest moments. Perhaps on a normal day she's sharp as a whip. That's the thing about working in the medical field, sometimes we only know what's right before us, yet we have to consider everything -- including that of which we have no clue.

Then again, it may have been the hypoxia talking. Or, better yet (and this is why I backed off instead of forcing it upon her as some might have done), perhaps she was simply overwhelmed by the moment. I mean, what would you think if you suddenly woke up to a huge mask blowing air in your face?

As, an hour later, she let me put the BiPAP on her and hence it is still on with the patient who is sleeping comfortably. It's amazing what a little TLC can do -- and the help of a wonderful nurses assistant.

Sometimes you know what's best for the patient, yet you have to become creative in how best to take the next step.

Answers to your web queries

What follows are web queries that lead someone to my blog, and my humble responses.

1. how we know bipap is failing: By observing the patient, checking ABGs, checking SPO2s, ETCO2, etc.

2. respiratory therapy for dummies: I could write this book.

3. do hospitals use oxygen or air to give ventolin? Either or.

4. drink albuterol: Pinheads do this.

5. how much does a respiratory therapist get paid: Not enough.

6. which is more effective mucomist by itself or mixing with albuterol: Never give Mucomyst by itself as it can cause bronchospasm. It should ALWAYS be given with Ventolin.

7. doctor of respiratory therapy: Doctors get so much more respect than RTs, but doctors also have a lot more stress and responsibility.

8. albuterol pneumonia: Why? Albuterol is a bronchodilator and does not go into the alveoli. It does not remove fluid and it does not reduce inflammation.

9. i drank lamp oil by accident what will soothe my throat?: If you drank this you best go to the ER, because you will probably be in respiratory distress. Chances are, if you wrote this, you did not drink it.

10. is beer bad for copd patients: Yes. It dried out your lungs.

11. full code patient: If your loved one is a full code patient, then if his heart stops we will do whatever it takes to try to revive him -- regardless of his age, regardless that he is terminal. I think it's crucial that you consider advanced directives before it's too late.

More on the agony of end of life issues

A few days ago I presented you, my faithful readers, the end-of-life story of one of my favorite patients. She had led a wonderful life, was terminally ill, was a self declared DNR, had a bad case of aspirtion pneumonia and, as per her families wishes, was set up on comfort measures only.

She was on a non-rebreather to provide her 100% oxygen in order to help her breathing, and she was even on morphine. She felt no pain. However, her breathing was mildly labored.

In my opinion, and the opinion of most people I have had the privilege to discuss this case with the past few days, this was the humane and ethical thing to do in this case. It was time to let nature take its course with this lovely 93 YO lady. It was time for her to go to her maker.

Yet, the doctor provided an option to the family, that he could have the surgeon do a bronch, and that this might buy her some time by cleaning out her lungs. And the family came to the difficult decision to allow the bronch.

So, yada-yada-yada, the surgeon sucked a bunch of brown crap from her lungs, and she was placed on a vent. This is where I left you guys off.

That first night her breathing was SO comfortable on the vent she wouldn't do any breathing on her own. The doctor had conceded she might be a major conundrum to get off this vent. In fact, he said something along the lines that she might be a terminal wean.

But he didn't know I was working.

Without an order I weaned the lady off 10 of PEEP and placed her in CPAP and PS. She did not fail the weaning attempt as I had surmised. After a half hour of the wean I did weaning parameters, and her numbers weren't good by any means, but probably good for her considering her terminal lung status.

Her NIF was only -17. We like it to be at least -20 to consider extubation. Her RSBI was 120, and statistics show 75% of patients with a RSBI under 100 do not get reintubated. Since she was over 100, her odds were not so good. Yet, despite these stats, the Internist on duty wisely decided to give the order to extubate -- after all, she was a DNR.

Now, 24 hours later, she is on BiPAP. She is miserable. She hates the mask. She looks so frail and unhappy. When I go into her room she wants me to hold her hand and talk to her. When I tell her I have to leave, her voice is muffled through the BiPAP mask: "Please, don't leave me alone."

She keeps asking me to take the mask off, but when I do her sats sink fast.

Now the Internist on the case does not want to give her too much morphine as to not knock her drive to breath out. And he doesn't want to put her on 100% oxygen because she is a CO2 retainer.

That ticks me off, considering she was on 100% non-rebreather for five days before she was placed on a vent and she did not stop breathing then. She tolerated the high oxygen quite well as a matter of fact.

Yet now, while her PO2 remains in the 40s, we are allowed to go no higher than 50%. Go figure.

Despite that, I was rather impressed with this doctor. When he was provided an opportunity to yank her tube, he didn't hesitate as some doctors have in similar situations I have experienced.

People, this is a perfect example of why sometimes it is NOT a good idea to take advantage of modern technology. Sometimes it is best just to follow the wishes of the patient, and let nature take it's course.

Are we prolonging life, or delaying death???

What I am going to write about tonight is something we need to have a major discussion about. Because I am convinced there is no solution to this conundrum. It's a conundrum because this terminally ill 93-year-old do not resuscitate (DNR) patient was placed on a ventilator last night.

In talking to her daughter, she led a wonderful life. She never held a job in her life, but her husband had a good job, so she didn't have to work. Instead, she stayed home and took care of the kids.

She has four kids, and all of them became successful in their own right. She was so proud that all her children turned out so well. And she's even more proud of her 12 grandchildren and three great-grandchildren. The flowers all over her room are a testament to how much she was loved.

When she was diagnosed with pulmonary fibrosis (PF) at the age of 88 she decided to make herself a DNR. Yet, even before the PF diagnosis she had become a regular fixture in the hospital with fluid overload, whereas her doctor said to me once, "Even a slight weight gain of 1-2 pounds quite often put her into pulmonary edema."

She was also a lifelong smoker. As a matter of fact, she smoked about a pack of cigarettes a day since the mid 1940s, when she started because it was in fashion to do so. As one of the negative and unexpected consequences of smoking, she has slowly developed emphysema, which has now progressed so that she has become a CO2 retainer.

Considering her grim prognosis, her doctor and family had decided to make her a comfort measures only patient, which justified placing her on a non-rebreather to keep her oxygen levels up despite the fact she was a retainer. But, despite the high levels of oxygen needed, she did not stop breathing (despite what believers in the hypoxic drive theory might contend. but that's a discussion for another day.)

The family had already been informed that their mother probably wouldn't live much longer without getting her lungs cleaned out, and that the best way of doing that was via a bronch. Yet, if the bronch were to be done, their mother more than likely would have to be intubated. But with her extensive medical history, she probably would need to stay on the vent at least over the weekend.

After a brief family conference, the family made the difficult decision to go ahead and allow the surgeon to do the bronch and risk the vent.

While the anaesthesiologist used a minimal amount of sedatives during the procedure, the patients sats consistently stayed low even on 100% FiO2, and the patient was not breathing over the vent when provided the opportunity. So the choice was made to send the patient upstairs to critical care, and to call RT to set up a vent.

As you know, when someone has to go to surgery they wave their right to a ventilator, at least temporarily. Even while a bronch is a simple procedure, it involved placing a tube in her throat, and the doctor peeking around her lungs with a bronchoscope.

As I was setting up the vent, the surgeon told me the right lung was completely filled with pneumonia, and he suctioned copious amounts of thick brown pneumonia not just from the right lung but from the left lung too.

The poor lady. My initial impression was that I'd keep her on the vent a few hours and wait for her to wake up and hopefully extubate her by morning, as I would any other post-op patient. But then I learned the story I just reported to you.

The problem with this case, as the Internist reminded me when he arrived on the scene to manage the ventilator, is that this patient is not weanable. He said, "How do we wean someone off the vent to respect a DNR order when she was on 100% to begin with. I know she's a DNR, but how do we ethically get her off the vent?

This lady was a true medical and ethical conundrum.

Did the family make the right decision? If they did nothing, there mother probably would have died soon. If they did the bronch, it might be possible to resolve the pneumonia, but still, the chance of her ever leading a normal productive life is gone. She is frail and has a terminal illness.

While the family assured me that they perfectly understand modern medicine cannot stop the inevitable, it might buy her some time, "so she can make it to her grandson's wedding in June."

Still, as one of the doctors said to me afterwords, "Are we prolonging life, or delaying death?" That is the question up for debate. What do you think? What would you do?

No Vent, DNR, or full code: what's your choice?

The decision of whether or not you want to be placed on a ventilator, or whether or not you want to make a decision for your loved one, is one of the most difficult decisions one can make. In fact, this is the basis of some very deep ethical discussions, and one of which may never be answered by society, only by the person who has to actually make that decision.

First let us note here that a majority of patients who go on a ventilator do so only for temporary purposes. If you have surgery, if you have severe asthma, pneumonia, or failing heart, you may need to be placed on a ventilator short term, just to get over the hump, per se. If a person is involved in a trauma, or if CPR is performed, then a person may be intubated and placed on a ventilator.

Those are easy decisions, especially when we are in emergent situations and are trying to save a life. However, there are also times when the decision to intubate or not to intubate can be complicated as complicated can get, and very stressful, and often disappointing if not discouraging.

In some cases you can plan ahead and write in your advanced directives that you do not want to be placed on a vent.  However, sometimes I have seen this declaration over-ruled at the point of impact when a person is in the emergency room and the person has to decide, "Do I want to risk dying now, or do I want to let these good people here in the emergency room help me breathe by placing a tube into my airway and assisting me with my breathing? Do I want to do that?"  More than likely, it will be, "Do I want mom or dad or grandma to die?"

Here I will provide some examples for you. All of these come from real life examples as I have actually seen them in my eleven years as a registered respiratory therapist.

One of the most frustrating examples to me was when a person decided they did not want to be placed on life support because, "I don't want to spend the rest of my life on one of those things," or "because I don't want to become a vegetable." In thinking this way, many people choose the following in their advanced directives: Full Code, Do Not Vent, or Do Not Intubate.

I have to cringe when I see that. I cannot believe any lawyer or doctor -- or advisor -- would recommend that option, because when a person's heart stops, and we have to do CPR on the patient, we also have to pump in quite a bit of medicine, and 99.9% of the time the patient does not survive a code breathing on his own: he has to be intubated and placed on a ventilator. Thus, if we do CPR, we have to put you on a vent -- there is no other option.

What might confuse people is what you see in the movies. There was one episode of "Walker, Texas Ranger," where Chuck Norris's character was having chest compressions performed on him, and his friend who broke his arm was watching on. Then Chuck woke up, the ambulance arrived, and the person who was taken away on the ambulance was not Chuck, but Chuck's friend with the broken arm.

It does not work this way in real life. The majority of the time when CPR is done on a person, that person buys himself a ventilator. That is, unless you are a DNR. In short, DNR means Do Not Resuscitate. That means if your heart stops we will not try to restart it. And, if you stop breathing, we will not place you on a ventilator. We will let nature take its course.

However, if the people working on you don't know you are a DNR, you will end up on a vent regardless. Not only is that the ethical thing to do, it's the law. If you're going to err, you err on the side of life.

However, I do think the decision not to become a vegetable on a vent is a valid issue for most people. Yet, one also has to consider the definition of a vegetable. Are you a vegetable when you have no body, but your brain is fully functional (as would be the case Lou Gehrig's Disease).  Or are you considered a vegetable when your brain if officially declared dead but your body continues to life?

Some people value life so much that they would want to live so long as they have control of their brain. That was my grandmas wishes when she was diagnosed with multi system atrophy, a disease similar to Lou Gehrig's Disease.  As a pro-life advocate, I totally supported her decision.

However, there was also the issue of depression and humiliation as you are fully aware that you have a tube up every orifice, and some strange person wiping you every time you have a bowel movement. Not only that, but you have to have someone assist you every time you move anywhere. Basically, you are a mind without a body. Do you want to live like that? Do you value life that much? Some people do. And we medical workers respect that.

Then you have the people who have Alzheimer's. These people will have fully functioning bodies but no mind. No mind no matter, no matter no mind. I would imagine that this might be the best way to end your life on a ventilator, if one had to choose between the two.

If I were an elderly person diagnosed with Alzheimer's, I would simply make a wish to be a DNR just so that I wouldn't become a ward of the state, a useless blob of skin on a bed taking up space and absorbing taxpayers money.

However, that would be my decision. I have to respect the wishes of others who think otherwise. Thus, life is very precious no matter how fragile, and each individual has to decide for himself. Grandma should be allowed to  choose for herself how she wants to die. This is why it is so important for physicians to be honest with their patients and talk to them about end of life options.

Then, let us consider the COPD patient who decides that he does not want to be placed on a ventilator. He is not necessarily end stage, but he is to the point that he cannot go without using his oxygen. However, he has a quality life to the extent that he is not one of those people who simply sits around and feels sorry for himself. He loves life. He loves living.  Yet he was also scared by the prospect that he might be placed on a ventilator and have to stay on it the rest of his life. So he makes the decision one day that he will make himself a dd not vent patient.

Then one day he is having trouble breathing. His wife drives him to the hospital and by the time he arrives there he is severely short-of-breath; his work of breathing is labored. The doctor looked the patient straight in the eyes and asked the question no one wants to ever hear: "If something happens to you, do you want to be placed on a ventilator?"

Of course now the patient is not in the planning stages. He is actually miserable, gasping for every breath. His oxygen levels are falling. His CO2 levels are rising. He is pooping out. He has a feeling of impending doom. He, however, does not want to die; he is not quite ready.

Then again, he does not want to go on one of those things either; he does not want to be intubated.

So, he asks the naive question that is really not so naive because the only people who truly knew the answer were standing in the bright room around him. Of course there were other COPD patients who knew the answer, but they were not in the room. His life, his destiny, was in the hands of the fine medical workers in the room.

"So," he says, huffing and puffing, barely able to get the words out, "How long would I have to be intubated for?"

"Well, the goal would be a day or two, but we really can't guarantee," the doctor explained. Of course she doesn't want to give false hope, but she also doesn't want the patient to simply give up hope at the same time. This is the ironic twist that we often face in the emergency room. She continued: "The goal is basically to rest your lungs and allow them a chance to heal. That's the goal. I can't guarantee anything, but that's the goal."

I stand there thinking, as I am getting my intubation equipment ready just in case the patient makes the decision, that the doctor made a good presentation. In fact, I couldn't have worded it better myself. The key words there were help you get over the hump and I can't guarantee anything.

By these short phrases the doctor threw the ball completely in the patient's corner. And, if the patient were to pass out, into the wife's corner. And if the wife were not there, the medical staff would have no choice but to make the patient a full code and do everything for the patient, unless they were 100% positive the patient was a DNR.

Another case I've seen is the elderly man with a chronically failing heart come into the hospital in respiratory failure secondary to the failing heart. The patient is non-responsive, and he is also not a declared DNR. The wife now is forced to make the decision of whether or not to allow nature to take its course, or to allow the medical staff to intubate her husband and place him on a vent.

"What should I do?" the patient's wife asks the Doctor.

"Well," the doctor says, "I know this is a difficult decision. Since you are in a very stressful situation right now and you want to make sure you don't make the wrong decision, perhaps it would be best to let us intubate your dad, and you can see how things progress, allowing yourself some time to spend with your family and to think. Then, in 24 hours or so, you can see how things are going with your dad. Either way, I can't make any promises. It's your decision."

The doctor pauses, allowing the patient time to think.  He then says, "Technically speaking, the goal of going on a vent is short term therapy to allow your husband's heart and lungs to rest. If things work out, he might come off in a day or two. However, I can't honestly say those odds are very likely right now. But, if things don't work out, he very well could be dependent, that's always a possibility. But if it comes to that, you can make a decision to terminate the vent if you wish."

After another pause, the doctor solemnly states, "However, if he doesn't go on a vent now, there is very little chance he will survive this."

Yes!  That was so true. The doctor was very honest with the patient.  He did was was necessary.

In this case, the wife decided to place her husband on the vent and the patient came off two days later with full mental capacity. Of course he was limited in what he could do, and had to go home with oxygen. And while his heart remained severely fragile, he was able to spend another two years with his family.

Thus going on a vent to get over the hump bought this man two years to say good-bye to those he loved, and allowed those he loved to say good-bye to him.

I talked to the wife a year after he died, she told me she was very pleased with her decision to place her husband on the vent. She said her dad was also very pleased.

One time we had a lady on a ventilator with ARDS, and as she was on the vent for the fourth week. It was becoming evident that she wasn't going to make it. The patient had already been given a slim 10-20% chance of surviving by the doctor.

But the family stood firm with their hope, and prayed the patient would not only come off the vent but have some quality of life thereafter. Even the family was starting to give up hope after a while, though. Then one day, as though by some miracle, the patient woke up and was eventually discharged.

I know that's a rare instance, but patients with grim chances of survival can survive. And while it might be fine to say, "I've seen people like this survive before," you still don't want to give a family member false hope.

Likewise, I have seen many cases similar to my above examples go in different directions. In the medical field, you just never know what's going to happen. And, when you are making end of life decisions, you never know what the right answer is.

There are times, though, where I would definitely recommend a DNR status. These would be elderly people over 90, and any person who has a terminal end stage illness. If you have an 80 year old lady dying of cancer, it would be kind of foolish to place that person on a vent, when all the vent would do is delay the inevitable, and cost the family insurance and taxpayers thousands of dollars in the process. I'm not saying that money is more valuable than life, I'm not saying that at all.  What I'm saying is that sometimes it's just noble to let nature take its course.

Yet, I see these people going on ventilators all the time. In many cases it becomes quite frustrating to see these people on the vent for weeks on end. And, this can quite possibly be one of the most frustrating parts of the medical field. Sometimes I even feel sorry for these people, especially when it appears to me they are trying to die, and their family members keep pushing for them to live.

Recently I placed a cerebral palsy patient on a ventilator. He is off now and back at home in the care of his family. The quality of life for this person was already pretty low, but the family loved this young man and truly valued the sanctity of life. We had to respect those wishes, and we took care of him as we would any other patient.

So, if you are wondering whether or not you want to be a full code or DNR, or whether or not you want to go on a ventilator should your body start to fail you, you should take some time to consider the what ifs.
It might be a difficult thing to stop and think about, but it could save you and/or your family members a ton of grief and stress.  It would help you and your family prepare for the end.  It would help you die with grace and dignity.  It would let you decide how you want to die.

As you can see, this is not an easy subject matter for anyone, including us in the medical field. And this has been and will continue to be an important ethical discussion for years to come, especially as we live in a world where we have the means to prolong life.