Immortal

He was shot in his neck in 1977 and since then has been paralyzed, unable to move a hand or a leg, nothign below his neck.

The hospital became his second home, he had a very supportive wife and family who never left him since that happened. Eventually he needed to have a hole made in his throat thought which he would breathe.

He was admitted to the hospital when I was on-call with a pneumonia (lung infection). His breathing was hard so we placed him on a ventilator (breathing machine) until the effect of the antibiotics would kick in.

Later that day the nurse called me saying ,"he's trying to pull out his (breathig) tube"

I went down to talk to the guy. He was completely alert and with it. He pointed to his breathing machine, tried to utter words which I could understand, "pull it out"

I brought him a pencil and a paper, and he wrote, "pull it out, I've had enough"

Pulling the tube out meant he would be off the breathing machine.

I told him, "you'll only need this tube today, tomorrow you'll probably get better and we'll take you off the machine and you can go back home with your wife"

He responded in writing, "pull it now"

"But you will die now if I pull it"

"That's OK"

In case you're wondering if it's legal or not, what is ILLEGAL is not following the patient's wishes as long as he is able to state what they are. He clearly was alert and had the capacity to make his own decision, "Pull it out now, I don't care if I die, I've had enough"!

I wanted to scream in his face "Are you shitting me?"

I tried to buy some time, "I'll call your wife and tell her to come now, is that OK?"

He nodded.
His wife and son arrived, and the nurse called again, "the wife is here, he still wants the tube out"

I went down to the ICU thinking of my bad luck. This man has been paralyzed for thirty years, has suffered like nobody did before and was OK with it, why on earth does he want to die now? IS it me? Was it that when he saw me he thought "I'd better die now!" I felt an inappropriate anger towards the dying man who was fearing life more than death.

I repeated this conversation in the presence of his wife and son. He repeated his request to stop the breathing machine. They begged him not to. They said they'd do anything to help him out. I told them that he'd probably die if we did and his chances of survival would be very low.

He was stubborn. He wanted it all off. We took everything off and I disconnected him from the machine. His son and wife stood by his side crying as I, cussing my damn luck, was watching his oxygen levels dropping. His oxygen level then stablized and did not drop further.

I was wondering if he can make throughout the day. The only hope was that the dosage of antibiotics he got would be good enough to treat his pneumonia and keep him alive. I conveyed that to his wife. The patient wanted to go home, so I arranged for that. I told the family again to expect the worst, but I had some hope since his breathing did not look too bad.

I asked the hospice services, who specialize in takig care of dying patients, to arrange for daily visits to his house to help his wife. I kept reading their note, and it looks like the man had a positive turn. It's been four months now and he is still alive off any breathing machine and without any hospitlization since that one!

It looks like death is not as selective as we think it is. It visits those who fight to avoid and avoids those who seek it. Those who fear death die a million times before they truly die, and those who don't fear death die only once.