Comfort measures only. What does it mean? Peel away all treatment, antibiotics, oxygen, IV fluids, tube feedings…start the morphine gtt and let nature take its course, right here in the hospital. Is this the kind of death I would want? I guess it depends on the alternatives. I can only wish that my patients could be in a better place near the end – at home, with the people they love. I only wish that I could give them something more here, play a role beyond doctor, bearer of sad news. Perhaps the hospital chaplains feel more fulfilled. I try very hard not to abandon or ignore these patients and there families, but I have a sense that the comfortable, familiar role which I have learned to fill is no longer of any use to them. I feel as though I need to play another role, but I am not quite sure what it is. Be by their side, comfort them, guide them as I did before. More than anything, I want to give them answers, certainty, a plan. But I cannot.

Death rates in medical ICUs vary from 8 to 20 percent, and are much higher when you consider how many patients die soon after they leave. The world of critical care is a world of those who are actively dying, young and old, from a variety of illnesses which we are not able to make better. COPD, congestive heart failure, cancer – so many diseases spiral out of control towards the end, and as medical professionals we are at a loss as to how to prevent this from happening. There are so many things we still do not fully understand, and so many things we do not know even how to begin to treat. This is the world of medical mystery – and of human mystery. We can hope for a miracle, or a peaceful passing, but beyond that we are reduced to mere human beings, standing beside our patients and their families, watching them suffer, unable to relieve all the intricate layers of pain and grief which lie beneath the surface.


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