Mr. Rogers

Today, I am leading the team this morning in the intensive care unit (ICU) when we walk into the room of Mr. Rogers. Mr. Rogers is a 64-year-old gentleman with a past medical history of sarcoidosis, a disease that damaged his lungs over the course of many years to the point where he can no longer walk more than a few steps before running out of breath. Mr. Rogers has been living in a nursing home for the past few years, tired and fatigued, stuck in bed all day, with trips in and out of the hospital becoming more frequent every time his breathing worsens. In fact, he has been to the ICU several times over the past three months, and it has always been the same routine: Mr. Rogers has trouble breathing, is taken to the hospital where he needs to be sedated to have a breathing tube placed down his throat, is connected to a ventilator for the machine to breathe into his lungs, and then feels better after a few days. At this point we wake him up and take out the tube so he can breathe again without the machine … until the next time he runs out of breath.

But this time it is different. Mr. Rogers has already been on the ventilator for more than a week and his breathing is not getting any better. His body is fatigued, and his lungs are so stiff that he is simply unable to take a breath on his own. We have stopped the sedatives and have woken him up, and we are testing his strength by pausing the machine for a few seconds, but Mr. Rogers is not taking any breaths on his own. He is alert, awake, with the tube in his throat, the machine pushing air into his lungs, and too fatigued to simply take a breath.

Mr. Rogers can communicate by nodding his head or moving his hands, and his misery is apparent from his facial expressions. The next step in his care would be to perform a surgical tracheostomy, cutting a hole into his neck so that a breathing tube can go directly into the lungs, but Mr. Rogers makes it very clear that he does not want the surgery. Having been stuck in bed for the past few months, he does not want to be kept alive by a breathing machine.