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.
Harmony Books

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:


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. No portion of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system now or hereafter invented, without permission in writing from the Publisher.