The Death of Stephen Y
The Least of These My Brethren: A Doctor's Story
of Hope and Miracles On an Inner-City AIDS Ward
by Daniel Baxter, M.D.
From the very first time I raised the issue with him, Stephen repeatedly
refused to consider signing a DNR. Characteristically, the more I would urge him to do it,
the more resistant he would become, like Tosca, adamant in her spurning
of the villainous suitor Scarpia. To my puzzlement and exasperation, he
would never tell me why he did not want to discuss the DNR matter. "I
don't want to talk about it, just resuscitate me, he would curtly reply,
then go back to reading his opera books, studiously ignoring my attempts
to pursue the subject further.
As the weeks wore on and his condition's downward trek continued unabated,
my entreaties to Stephen about CPR and DNR issues became more urgent, primarily
because I knew he could succumb at any time to one of the numerous complications
afflicting him. Thinking that he did not fully realize what CPR and life-support
systems entailed, I would try to describe life in intensive care on a breathing
machine in lurid terms: how he would have tubes in every body orifice (nose,
mouth, penis, rectum), how we would probably have his hands and legs tied
down so he could not pull out these tubes, how he would be sleep-deprived
and eventually psychotic from the constant noise and stimulation swirling
around the intensive care unit. I emphasized how it was extremely remote
that he would ever recover and get off the breathing machine, and how it
would be difficult, if not impossible, to ever disconnect him from all of
these tubes and let him die in peace once the threshold of CPR was crossed.
Day after day, especially when the pace of his decline accelerated, I would
repeatedly emphasize how he did not seem to understand what horrendous atrocities
medical technology could wreak on his mind and body-- that simply because
medical science could keep his body "alive" for a few extra hours
or days after a cardiopulmonary arrest did not make it right.
My exhortations were to no avail. The more I begged or cajoled him to
become a DNR, the more steadfast he became in his refusals. He never responded
to any of my horror stories about CPR and never attempted to justify his
refusal to sign a DNR. It was simply an issue the two of us could not even
begin to navigate. Stephen's persistent refusal to heed my warnings perplexed
and angered me. At first, I thought he was ignorant about how horrendous
CPR could be, how miserable life on a breathing machine in intensive care
could be. I tried to theorize that his apparent pigheadedness was his way
of exercising what dwindling control he still had over his body, especially
since in his constricting world he could not even control his own bowel
movements, let alone be independent enough to attend an Emerson String Quartet
recital. I simply could not figure it out and eventually became emotionally
exhausted from my daily exhortations. Moreover, I began to feel I was becoming
a bit obsessed with Stephen's code status-- after all, it was his
life, not mine, that was at issue. Finally, the day after I twisted his
arm particularly hard on the matter, I saw on my daily rounds something
in Stephen's room that I will never forget. Taped on the wall directly over
the head of his bed was a letter-sized piece of paper on which was printed
in pencil, in weak and scrawled handwriting:
PLEASE RESUSCITATE. THANK YOU.
This was Stephen's desperate plea for life-- life at any cost, no matter
how slim the chances of recovery from CPR, no matter how agonizing being
kept "alive" in intensive care might be. Stunned and dumbfounded--
I had never had a patient make such a dramatic gesture for life at any cost--
I thereupon resolved to stop raising the issue with him any further. His
pitiful little sign over the head of his bed put the controversy to rest,
at least for a time. Stephen had won the test of wills with his doctor,
as he should have.
©Copyright Daniel Baxter, M.D. 1997. All Rights Reserved.
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