For ten years the stooped, generous form of my patient Abuela G. had shuffled through the doors of our community health center. For ten years her hand-knit panchos had brought color, the deep smile lines etched in her face had brought warmth, and the twinkle in her brown eyes brought light to our clinic-- especially when she proudly said hello to her grandchildren who work with me. For nearly ten years I had documented in her chart that she wanted to be “full code,” that she wanted “everything possible done to save her” if her heart or lungs failed.
Now nearly 90, she was hospitalized with heart failure and worsening dysfunction of multiple other organ systems. I was grabbing supper before evening clinic when I got the call. “Please come immediately- Mrs. Garcia is looks terrible. She needs the ICU and intubation. It's sad she's a full code because that doesn't seem appropriate.”
On the way I met a crowd of family members in the hallway, and said hello to the ones who worked with me. They had been thrown off the floor by the nurse for being a physical obstruction. When I got to Mrs. Garcia's room, there were another dozen family members squeezed in, touching her, praying for her, massaging her hands and feet. Tears shone in their eyes. Icons of the Virgin Mary and other saints were arranged over my patient's body. Her chest muscles heaved as they tired out from the effort of keeping her alive. Her blood pressure had fallen dangerously-- she looked like she wasn't long for this world.
Two days prior I'd read an article from the pediatric palliative care literature calling for a moratorium on the phrase “Do everything.” I closed my eyes and felt my heart join with the family in their prayer. When it ended I stroked dear Mrs. Garcia's face and said “It looks like God might be inviting you to come home. I know you've always said you wanted us to 'do everything' in this situation, but it is not physically possible to 'do everything.' When your lungs stop working, I can place a breathing tube down your throat, but I will have to ask most of your family to leave so our team can work. When your heart stops, you can have your family here loving and touching you as you go to God, OR we can do CPR and shock your heart with electricity. We can't do both. I am happy to help with whatever type of care you prefer, but I need you to tell me if you want to keep your family here doing what they're doing for you or if you would like us to take you to ICU and focus on medical intervention.”
Silence...broken only by the electronic heartbeat monitor beeping and wet rattly breathing. Then finally, “I want to be with God.” In six words my patient allayed the angst of her family and care team, paving he way for what turned out to be a surprisingly peaceful night filled with family, prayer and holy water. It felt like God's Spirit brought peace once she made that decision, and she got to go home with hospice care. A week later, surrounded by loving family, her spirit entered rest.