Dear Mrs. Canseco,
You and your husband have had a long, fulfilling life together. Ever since your marriage over 50 years ago, you have stood by his side through good and bad times. And when he was diagnosed with end-stage lung cancer this year, you were there ready to support him to his last breath. However, there comes a point when devotion gives way to fanaticism—and you cross that line a few weeks ago.
When your 75-year-old husband was admitted to the hospital two months ago in respiratory failure, the admitting physician was not being cruel when he inquired about Do Not Resuscitate status. He had nothing personally against you or your husband when he brought up the idea of seeking Hospice care.
You wouldn’t hear any of it. You demanded that your husband be placed in the intensive care unit and be given round-the-clock supervision by nurses and physicians. When I spend five minutes with your husband every morning pre-rounding, followed by another 30 minutes telling you that nothing has changed in the past 24 hours, stop accusing everyone on the staff of “not explaining what’s happening.” Your weekly family conferences where my attending and I sit down with you, your three children, your brother, and two of his kids are really getting to be a drain on our time. I just don’t know how many other ways I can tell you that after being in a coma and on a ventilator for the past two months, your husband really doesn’t have a shot in hell of living through this. You have refused pain medications, saying that we are, “Killing your husband.” You have declined a Hospice evaluation, stating that, “We are turning our backs on your husband.” When we brought in a pulmonologist to reevaluate the situation, only to have her agree with us, you accused her of, “Not knowing your husband.”
But expertise be damned. Your daughter, the massage therapist who has had extensive training in medicine, told you that she believes your husband will make it off the ventilator without any problems if we just wait a little longer.
You’ve treated our hospital like it’s a hotel, having moved in and spent 61 consecutive nights sleeping in your husband’s room. You have refused to leave the room under any circumstances, claiming that bad things would happen to your husband if you walked away. You have demanded that the hospital provide you with meals from the cafeteria three times a day. You have demanded that nurses be forever present in your husband’s room so that they can respond to your every beck and call. You have neglected that these hard-working nurses have four—sometimes five—extra patients who are also very sick and must be seen. I wish I could just put a white coat on a mannequin and place it in your room to try to give you some kind of solace. He could have an outstretched arm to hold your hand with an audio tape on continuous replay saying, “I am here for you.” Because in the end, that’s all that I can offer you at this point.
And then there’s the issue of the money. Don’t act like it doesn’t exist. The combined hospital bill from your stay so far is going to run well over $200,000. But you have never cared how these services are going to be paid. You proudly flaunt that you have no insurance and since you’re not an American citizen, you are ineligible from Medicare. Neither you nor your husband own any property. When it comes right down to it, we’re all really working for you for free.
You have shown us that you know more about the pathophysiology of a coma than any physician ever could. You have taught us that living on a ventilator is better than dying with dignity. You have pointed out that our nurses are incredibly mean and lazy for not dropping everything they’re doing in another patient’s room to come see your husband, whose condition has not changed in two months. Thank you for giving me the opportunity to learn by having your husband as a patient. Thank you for teaching me that everything my attendings tell me is wrong, that medical care is free, and that nurses don’t care about people in a hospital.