Grief and Challenges of End of Life Treatment

By Benjamin Schnapp, MD

“Tell me about your mother.” That is always how it begins. There was never quite enough time the last few years, time to put her affairs in order, time to talk about the unpleasantness that comes at the end of life. Now here we were, standing watch beside her stretcher in the emergency room. Upstairs was the grim certainty of the intensive care unit, the ceaseless beepbeep-beep of the life-support machines, the endless expensive tests that would likely all be for naught.
Yet there was the fear. There was always the fear. “You mean you didn’t do everything for mom?” There was always more that could be done. The latest and greatest antibiotics to cover for this, another cat scan to examine the progression of that, a dash of electrolytes here, some anticoagulation there. The bills continue to pile up, but mom isn’t getting better. Can’t stop now. So sprinkle on another procedure, plus a hearty helping of specialized consultants (who can remember the names of all the doctors that pass through now?). Still inching closer and closer to the end, week after agonizing week.
Then, when the end comes: chaos, violence. The overnight intern, eyes still blurry with sleep, a stranger to mom, enters and begins pounding furiously on her chest to attempt to restart her heart. Meticulously arranged sterile kits are torn open, their contents spewing onto mom’s bed, more doctors, more pounding, more needles, more tubes; her blood is spilling onto the floor now. Forty-five agonizing minutes and no success; the team wordlessly slinks away into the night, a senseless, costly coda to her life.
And so instead we talk. We talk about what sort of person her mom was. What she loved, who she loved, how she liked to spend her Saturday afternoons in that particular corner of the park, that time the dog got sick and they all ended up cleaning up the kitchen at two in the morning. There are other patients waiting to be seen, but they will have to wait just a few minutes more.
Slowly, we arrive there. It’s where we nearly always arrive, and it never takes quite as long as you’d think. Mom never would have wanted this, this suspended life in the hospital, a nest of wires running in all directions, tubes snaking up to the breathing machine, whirring and hissing to keep her alive. She was simply not that sort of person.
So instead, the catheters and monitoring are carefully removed, the endlessly beeping machines are turned off, and the medication is given to make sure she’s comfortable. A little oxygen to help with her breathing. A quiet place for family to be together. And, after a few minutes, a few hours, or a few days, peace.
Today, tomorrow, or next week, the dance will begin again. And it will be time, once again, not just to save the patient’s family untold thousands of dollars or weeks of grief in the ICU, though it will certainly do that. It will be time to help them get the highest quality death that we can offer as providers. “So, tell me about your father…”

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Benjamin Schnapp, MD, of New York is one of the four remaining finalists in our 2015 Costs of Care Essay Contest.