“Illness gives us that rarest thing in the world-
a second chance, not only at health but at life itself.”
They called me to see her because she was critically ill. She had done very well for a woman in her early eighties. She lived by herself, ate well, was able to drive to the supermarket and the hair salon, and had no trouble with personal care. One day she developed a cough; the next a fever. Within three days she was gasping for breath and she could barely move.
The diagnosis was pneumonia. Her chest X ray showed numerous patches where the air spaces had been taken over by what we call infiltrates. She was given two powerful antibiotics and did not improve. In fact, she got worse by the day. Because of the lack of response to antibiotics, additional tests were done. I was called because they signaled the presence of a severe autoimmune disease.
When I got to intensive care they had placed a tube down her throat to help us keep enough oxygen in her system. Of course, she could not talk, and she was heavily sedated. I had my work cut out for me.
I asked the nurse to find me a family member that I could talk to. I was not sure that she would survive. She had a great-niece that came to visit every day. My patient had never married; there were no children and no surviving siblings.
The niece was a very pleasant, well-educated young woman. She understood the gravity of the situation, and showed quite a bit of concern. Her fiancé lived with her and was also very supportive. I could see that these two relatives would be of great help if we could get her better.
Which she did, and how! She tolerated huge doses of cortisone without a hitch. She did not develop any side effects to the powerful immunosuppressive medicine that was prescribed. Within two days, she was breathing on her own. Within a week she could walk and feed herself.
She was doing too well to go to a rehab unit, and her niece would not allow her to go to a nursing home. The young couple took her in until she was strong enough to be able to go home. This temporary arrangement lasted for years. The young couple did not find her to be a burden, and she found out that she did not look forward to being alone after the scare that she had gone through. She sold her home and rewarded her niece so well that they were able to buy a bigger home that provided ample room for the three of them. They frequently went out as a group. A dog joined the household. At one point my patient told me that these were some of the best years of her life.
When she reached her late eighties time began to take its toll. She developed a painful neuropathy of her feet. The disease robbed her of her strength and coordination. She often felt that she was about to fall. She could not sleep because of the pain. She did not want to leave the house because she was afraid of falling in a public place.
She tolerated these problems with exemplary courage, but I could tell that she was worried about what would become of her. Her concerns were well- founded. Soon she developed incontinence, both of stool and urine. She could not walk three steps without leaking. Her niece and her (by now) husband did a great job of cleaning after her, without a hint of complaint, but the embarrassment was too much for her to bear.
She fell one more time. They brought her to the office; clearly a worn-out and defeated woman. Gone was her well-done hair; her fashionable blouse; what she used to refer to as her sexy slacks. She wore pajamas, which were a bit soiled. They had to wheel her in.
We went over her ailments once again, and her exam showed nothing except the devastating loss of nerve function below her waist. She was in tears.
I said something about trying to find a nursing home. Her niece and her husband both said that they would somehow make it work without placing her in an institution. Their concern was how depressed and ashamed my patient was.
I held her hand; I tried to get her to establish eye contact with me. She could not stop crying. After a minute she finally spoke.
“Why did you save me?”
Loud. Angry. Almost spiteful.
An excellent question. For one of the few times in my career, I had nothing to say that I thought would help. I lowered my head and I held her hand a bit longer.
They took her back home. Her niece called three days later. My patient had fallen again. She refused to eat, and she did not want to go to a hospital. I sent a prescription for pain medicine, in case that she would need it. She died within four days.
Why do we save older people? Because she had a treatable illness; because she recovered and had a wonderful time after she healed. Because she had a support system: people who loved her and went way out of their way to help.
Yet I knew all along that her eventual slow and painful deterioration was a distinct possibility, given her age and the presence of a life-threatening autoimmune disease.
When do we say no? How can we tell if a patient has a few good years left, or if they will end up angry with us because we saved them?
I still feel her anger. When I think of her, even after all these years, I cannot think of anything that I could have said to her; no words that could lessen her pain. There are days that I bring up a mental image of that visit. I always end up looking away from her while I hold her hand, speechless. My only consolation being that we gave her a second chance at life, unaware of the consequences.