On the last day of her life, your mother went on a spending spree. I intubated her at around 9AM and for the rest of the day we threw money at her, successfully keeping her alive until about dinner-time when her liver cancer finally had enough, gave us the finger, and showed us who was really in charge. It was not a pretty death, but then I knew it wasn’t going to be when I only just managed to jam the breathing tube through her vocal chords before they were obscured by blood and other unwholesome-looking fluids. Still, over the course of a very interesting day she got an expensive bronchoscopy , five or six lab draws, a central line, an arterial line, three units of blood, a chest x-ray, continuous nursing, pumps, fluids, two consults, monitors, blinking lights, and the usual buzzes and beeps.
We did everything but put a coin under her tongue for the Ferryman which, considering the outcome, would have been just as cost-effective.
The next time, please pay attention to what we have to say when we have “The Talk” like we did two weeks ago to tell you that your mother had passed beyond the limits of our abilities and all we could really hope to do was to ease her suffering as she died. Unfortunately, as we live in an egalitarian age which worships your autonomy, when you seemingly ignored our advice and said, “Do whatever it takes,” our hands were tied and we committed ourselves to two weeks of slowly torturing a dying woman. I understand how you feel about your mother. I have a mother too but you can’t have really wanted this. We coded and shocked her, what? three times in the last eight hours? It had to have hurt her the first time when there was actually something of your mother to bring back. After that, well, I just don’t know.
Not all life is priceless. Not even your mothers. When you said, “Do whatever it takes,” what you really meant was, “Do whatever it takes as long as I’m not paying for it.” But there are very real costs associated with medical care and somebody is paying them. I don’t mean to lay this burden on you but since you want the autonomy to make medical decisions, you need to have all of the facts. Would you have ignored our advice if you had to mortgage your house to pay for your mother’s last two weeks of futile care?
Medical care, like most resources, is scarce and there’s never going to be enough to go around. Somebody has to decide how it’s going to be allocated and for better of worse we seem to have elected you even though you seemingly have no interest or incentive in the matter.
I don’t think you made a good choice here. That’s all. Medical care is for the living. Your mother needed hospice and maybe to die at home peacefully.
This doesn’t mean I don’t think we should spend money on the critically ill. I don’t know how much a year or two of life is worth and we certainly get sick but otherwise highly functional patients who we can return to a happy and meaningful life. I’d hate to make that kind of decision based on simple economics, assessing the value of a year with actuarial exactitude and making decisions accordingly. On the other hand there is a difference between critical care and futile care. Maybe I can’t define the exact line separating the two but I know the difference when I see it. Perhaps you were too emotionally involved to make the distinction and it was unfair to leave it up to you. It’s hard to let go, especially as the popular culture has conditioned us to expect medical miracles although I don’t know what you were expecting with your mother. The eventual outcome had never really been in doubt and you knew perfectly well that you mother was not going to be leaving the hospital this time.
When I pronounced you mother and closed her eyes for the last time, the ancient stillness of the tomb was deafening.