Extraordinary measures for an extraordinary father

A few days ago, while my dad was being treated at the hospital, we felt it would be appropriate to broach the subject of extraordinary measures. Should things digress to the point of no hope, would my father want us to do everything possible, including the use of machines, to keep him going. He's a proud and strong man, despite his current condition, and, to no-one's surprise, he indicated heroic measures would not be necessary.

Today, minutes before I was to leave home to visit the hospital, my mom called me. She was crying hysterically, and said that I needed to get to the hospital right away. I had been talking with my sister when the phone rang, so when I got back to her, we decided to go together to the hospital. My dad had bled out, and was being kept alive by massive blood transfusions. We rushed to the hospital.

By the time we got there, my dad had been disconnected from the blood supply, but was still alive. The on-duty doctor explained that his bowel was probably ruptured, his blood pressure couldn't be maintained for very long, and he prepared us for the end. There was, he said, a slim possibility of prolonging his life with surgery, but the prognosis was not good. Again, we put the question to my dad about the possibility of surgery, and again, he said he had had enough. As he began to slip away, I placed a call to my sister in Toronto, hoping that somehow, she would be able to get down here in time to say goodbye. We also called the rabbi.

Within a half hour, my dad's blood pressure had dropped to the point where he needed to be transfered from the ward to the ICU. In the ICU, where they are better equipped to deal with such outbreaks, they started a couple of new lines from which they could infuse blood into his system more quickly. The standard veins in his arm had collapsed, as had one lung. Renal function was severly decreased, and oxygen levels were falling to critical levels. Blood pressure was now being reported in grim terms.

The doctors' efforts in the ICU were unbelievable. Within an hour, they had stabilized him to the point where the family could once again come to his side. Except for my sister, who was still making her way in from Toronto, the entire family was at the bedside, including some very close cousins whom we had contacted from the hospital. The ICU doctor gathered the family to discuss options. None were particularly good, although he made it clear there were still options available to us to try to extend my dad's life and give him one last chance at recovery. Being fully aware of my dad's intentions, we initially balked at any heroic measures. We were leaning more toward providing a sedative that would allow my dad slip quietly away in his sleep. But then, we started to think about the options. As described, although they weren't particularly optimistic, the doctors did indicate that if they could determine the cause of the internal bleeding, and if the damaged tissue was relatively localized, there was a chance that his life could be saved. With much help and physical therapy, my dad might once again enjoy a quality of life that would be worth the effort.

Our family approached his bed in the ICU. By now, he had blood being fed from three separate lines, and oxygen was also being administered. We could see the monitors showing a lower than ideal rate for blood pressure, respiration, and pulse. Oxygen levels were all that was acceptable, and that was due to the massive blood transfusions. We explained to my dad what the doctor had told us... that without further treatment, he would be gone by morning; and that with treatment, there were no guarantees. We told him he'd need to be placed on a ventilator soon, to preserve his respiration and reduce the need for the blood, which, while keeping him alive, was complicating the efforts to keep him breathing. We told him that after some tests were run, he might have to have surgery to repair his bowels, or that his bowels may completely die and have to be removed. We told him he might have to use a colostomy bag for the rest of his life. Most of all, we told him that we all loved him, and weren't prepared to say goodbye if there was even a chance that he could be saved.

Finally, it was his choice to make. He looked at us all. And then he said "I want to fight". So now, we have a clear directive. The test will be done. Surgery will be performed if required. He may die tomorrow in the process, but it won't be because he gave up on life, or because we allowed ourselves to give up on him.