Expert: Margot RN BScN CGN - 9/6/2006

Question
Hi Margot,
I have a good friend and former coworker, 52 years old, who has been battling leukemia (AML) for the past 9 months.  I work in an office job at the same hospital he goes to, and have been visiting him when he is here for chemo.  He had his last chemo about 2 months ago and was in remission and doing very well.  Suddenly he was hospitalized a week ago with enlarged spleen, pain, bleeding gums, breathing problems.  I have visited him 3 times during the past 7 days and he has declined rapidly.  I was visiting last week when the doctor came and told him there is not much hope.  This week I visited to find that he is now in the ICU, sedated and on a ventilator and a dialysis machine and some other equipment.  It looks to me like he is dying and the machines are keeping him alive.  Of course since I am not a family member, I can't ask the staff for medical information (I know that is a HIPAA violation).  I am getting what information I can from another friend who is getting updates from his wife.  I don't know the wife all that well, only met her a few times, so I am not comfortable to call her.  Yesterday I spent about 10 minutes with him.  I stroked his arm and talked to him.  It was hard to do, and I felt in my gut that I was saying goodbye to him.  His skin is grey and also jaundiced and his eyes were barely open (which they said was awake for him).  He does not look like the friend I knew.  Apparently 2 days ago, the Dr told his wife that she needs to make a decision about unhooking the ventilator.  But 48 hours later he is still on the machines.  I am struggling to understand why they would have put a cancer patient on a ventilator to begin with, and why they keep him on it.  It was not his wishes to be hooked to machines for any lengthy period of time.  I am sure his wife is in some sort of denial and having a hard time accepting this situation and letting go, especially since he deteriorated so quickly.  But still, what medical reason would the doctors have for keeping him on the ventilator and other life support?  I can't lose the mental picture of him with the tubes going down his throat, or of the look in his eyes, which had lost the spark of life.  He looks miserable.  I know he is under sedation and probably not in pain, but I think he should die with dignity.  Why would they prolong his suffering and misery?   
Thanks for your help with my struggle to understand,
Katie

Answer
Hi Katie and thanks for writing,

I can not imagine why any doctor would put a terminaly ill patient on any kind of life support?! The only thing I can think of is maybe he had an incident where he appeared to be struggling and perhaps he or his wife requested it - I would hope the medical staff would advise against it, but they may respect the request.

Sorry I can't be more specific as I obviously don't know the details and I've never seen this treatment in palliative care in 20 years.

I hope your friend's suffering is over soon so he can be at peace.

God Bless,

Margot