DOING ALL THEY CAN - PHYSICIANS WHO DENY MEDICAL FUTILITY

The House of God found it difficult to let some young terminal guy die without pain, in peace. Even though Putzel and the Runt had agreed to let the Man With Agonal Respirations die that night, his kidney consult, a House red‐hot slurper named Mickey who'd been a football star in college, came along, went to see the Agonal Man, roared back to us and paged the Runt STAT. Mickey was foaming at the mouth, mad as hell that his “case’was dying. I mentioned the end‐stage bone cancer, and Mickey said, “Yeah, but we've got an eight grand dialysis shunt in his arm and every three days the dialysis team gets all his blood numbers smack back into line perfect.’Knowing there was going to be a mess, I left…. I thought of the bones in multiple myeloma: eaten away by the cancer until they're as brittle as Rice Krispies. In a few minutes the Man With Agonal Respirations would have a cardiac arrest. If Mickey tried to pump his chest, his bones would crunch into little bitty bits. Not even Mickey, seduced by the Leggo's philosophy of doing everything always for every patient forever, would dare call a cardiac arrest. Mickey called a cardiac arrest. From all over the House, terns and residents stormed into the room to save the Man With Agonal Respirations from a painless peaceful death. I entered the room and saw an even bigger mess than I'd imagined: Mickey was pumping up and down on the chest and you could hear the bones snap, crackle and pop under his meaty hands: a Hindu anesthesiologist pumped oxygen at the head of the bed, looking over the mess with a compassionate disdain, perhaps thinking back to the dead beggars littering dawn in Bombay: Molly [a nurse] was in tears, trying to follow orders, with the Runt shouting, “Stop! Don't resuscitate him!’and Mickey cracking and crunching and shouting, “Go all out! Every three days his blood numbers are perfect!” 1 She had a blood pressure of 40 for three or four days and we gave her wide open drugs to keep her pressure up. This lady was bleeding out of her eyes, her ears, her mouth, and she was blown up like a toad. We put washcloths over her eyes and within two minutes they were saturated with blood. When she finally started coding, they actually did CPR!… The resident on the unit at the time had very strong belief that this was cruel and he told the attending doctor “If you code her, I will walk out of this unit.’And the attending said, “No you won't,’and the resident said “Yes, I will,’and that is exactly what he did…. I first thought this attending was acting because of legal aspects, but now I think it was a power trip—it was like he was saying “We're not going to do what you want, I'm the one who is in control here.” 2 Copyright © 1994, Wiley Blackwell. All rights reserved