Two Sad Deaths

Mr. Brown weighed 650 pounds. He was 39. I have no idea how or when he gave up on life but he did. He died an undignified death the other day with his family and his pulmonologist deciding that the point of medical futility had been reached. I had miraculously managed to get his heart beating again after he arrested on the floor. Correction, me and an anesthesiologist and about 15 nurses. He "lived" another two days on a ventilator before the endotracheal tube was removed and he ceased to breathe. Really he suffocated. He was too weak to expand his massive chest. He was broken.

Mrs. Gilroy was also 39. She married a soldier and moved to this country from Thailand some years ago. She had a child. She got divorced. She lived alone. She had squamous cell carcinoma at the base of her tongue. I'm sure she smoked but it doesn't matter; she may have just been dealt the ace of spades in her chromosomes. She came into the ED with hemoptysis... coughing up blood. She was in the middle of chemotherapy and radiation therapy and she was unstable. Her heart rate was 150 and her blood pressure was in the toilet. She also had no platelets and so she couldn't clot to stop her bleeding. I told her in the ED that I needed to intubate her to save her life. She had been intubated before and when I told her I saw her give up. Her shoulders slumped and her face fell and I imagine she resigned herself to her fate. I almost couldn't get the tube in because of the distortion of the posterior pharnyx from the cancer. I knew she was going to die, I just didn't know how soon. I went to check on her yesterday and the ICU nurse told me she had died in the night. She never came off the tube. I don't even know if she had adequate sedation on the vent because the ICU nurses told me she was quite aware. She died alone and unable to speak, with all of us trying desperately to help but none of us able to. All in all a sobering week in the department.