He was hit from behind. He was only driving about 45mph, and being 91, I guess we should forgive him that. I don't know any of the rest of the details about what happened to him that day, and I don't want to. From the looks of him now, it was the horrible beginning of a horrible end.
He is hooked up to a ventilator, strapped down to the bed, his swollen and disfigured head rigidly fixed in place by a collar designed to prevent him from moving his broken neck. It's been days since his accident, but he is still crusted with blood and dirt. We want to get him off the ventilator, because he has developed pneumonia, as many on ventilators eventually do. But if we lift his sedation enough for him to breathe on his own, he will be in excruciating pain because of his many fractured ribs, so we called Pain Control to come and place an epidural. I came back from lunch to find four strapping Anesthesia residents standing outside of his room, shaking their heads. Neurosurgery had nixed that idea, they said. They had been told that the patient's neck was too unstable, and that he could not be rolled onto his side for the epidural placement in his spine. Instead, Neurosurgery would come (when?) and put screws into his skull to attach him to a rigid armature that should stabilize his neck enough to place the epidural. The apparatus is called a Halo. Once we're done with this poor man, it won't be the last one he wears.
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How to proceed? I have sympathy for the man and his family, and even for the person that hit him, but who decides how much to invest in saving him? And what if he were 35?
Having worked many an ICU shift as an anesthesia resident I have guiltily caught myself wishing just this sort of patient would die. I despair about spoiling what could have been a peaceful end to a long, wonderful life.
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