What a crazy night. Shortly after I last blogged, the code pager went off. As MICU senior, I still respond to codes, although thankfully my responsibility is mainly airway, and not code team leader as a few months ago.

Elderly male with a-fib on anticoagulation, as well as a right upper lung mass, who had a massive upper airway bleed. And it was massive: he spewed blood everywhere, and dropped his hemoglobin from 11.3 to 8.6 in minutes. He had to be intubated to protect his airway.

It was a rough night. Saw some friends at the end of my 30 hour shift. People could see I had a bad night; I just didn't want to talk to anyone, but leave.

Did attend noon conference before I left. It was an ethics lecture, focus mainly on the recent passing of Terri Schiavo and the ethical, moral and legal dilemmas the family had to face. Without sounding like I'm taking sides (but really, I am), I wonder if the family knew what they were going to put her through, wanting to leave the feeding tube in.

Terri was a young, married woman who went into cardiac arrest at home. By the time EMS got to her, she had been pulseless for a significant amount of time, and as a result, although they were able to revive her, she had irreversible anoxic brain injury, which led to her being in a persistent vegetative state. She had a feeding tube placed through the abdominal wall directy into the stomach. Her husband cared for her for many years before deciding, as her legal guardian, to stop the feeding and let her go. This led to a huge falling out between him and her family and many many court sessions. People were demonstrating in front of her husband's house. Even received death threats. In the end, after 15 years of being alive but not living, she passed on.
Morally, perhaps this may be wrong, letting someone go. But, I wonder if all these 'pro-life' people know what it means to be in a persistent vegetative state? Yes, it sounds nice, keeping someone alive. But have they seen the massive pressure ulcers people get just lying in bed, the ones that are so deep that you see pelvic/hip bone? The complications of being bedbound? Of tube feeding?

I think all in the audience today are 'pro-life'... after all we're all doctors. But having seen things this side of the fence, I think all of us would agree with her husband's action.

For the record, if ever I'm in a situation like that, please let me go. Extreme measures only if expected quality of life is decent, but otherwise, no long-term mechanical ventilation, no tube feedings.

This case is making a lot of Americans aware that they should have advanced directives to dictate their care should they become unable to decide for themselves.