Monday, November 12, 2007

Please Let Me Go

He lost his wife to cancer 4 months before, his precious Betty Sue to whom he had been married for 40 years. He began drinking the day of her funeral and hadn't stopped. One Sunday evening, he decided he had had enough and wanted to join Betty Sue. So he drove himself in front of a semi truck.

He was still alive.

He was still conscious.

The trauma team was ready, the flow went smooth. Our patient ended up with a left chest tube, lacerated spleen, a tear in his intestines, pelvic fracture, a femur fracture, bilateral forearm fractures, and a minor closed head injury. Before we intubated him for his emergent trip to OR1, he kept screaming "Let me die! Let me die!" He was sobbing and saying he wanted to be with Betty Sue.

His son arrived just before we were planning intubation. "Steve - tell them to let me die! I need to be with your mom. Please! Please!" His son was crying and shaking. "No Dad, I can't. I can't lose you too."

"Please Steve, please let me go," his dad replied.

"Damn it Dad! No! Stay with me! I need you here!" Steve yelled at him.

His Dad turned his head away from him and refused to speak again. He was crying the whole time. As our physician explained to the patient what we were going to do (intubate, OR, etc), he made no indication that he was listening. He just cried.

This man was 60 years old and had the potential of many more years of life. The stress of the situation could have been warping his view of what he wanted. The head injury could be doing it too. He wanted to die, but only to be with his deceased wife. What ethical road do we take here?

The gentleman ended up in ICU for 6 days. The entire time in ICU he was asking the nurses to let him go. Telling them he wanted to die. He had multiple consults with psych/mental health/social workers to no avail. He was still determined that he wanted to die. He refused to speak with his son or any other family members.

On day 7 he was transferred to the Surgical Trauma floor where he promptly coded 35 minutes after arrival. They worked on him for 40 minutes before they called time of death. Many of us have often wondered if he did something to assist his death since he was no longer under 1:1 observation. He was so determined to die.

This was one of the saddest cases I've been involved in. He had sunk so deep into his depression after the death of his wife that he couldn't even reach the edge of rational thought. How do you fight something like that? I think when someone has made a decision to commit suicide in a large manner (driving in front of a semi truck, shooting self in head, etc), there is no turning them back. He was intent on joining Betty Sue, and he eventually did.


MY OWN WOMAN... said...

The demon we call grief takes lives in so many ways. After his wife died, your story indicated that he had already died emotionally, he just wanted to follow with the physical. What a terrible place to be when the only hope one can imagine is the release of death. My heart goes out to him, and his son.

NocturnalRN said...

I tell you though. I am always leary of patients who say they want to die. It is like they can will it or something even when you don't consider their situation to be necessarily life-threatening. Poor son!