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tonight on front line an intimate Journey to the edge of Life nobody wants to die and nobody wants to die badly Into the Heart of modern medicine there's almost always something else that we can do to put off the inevitable where patients families and doctors face the hardest decisions if you're tired and you don't want us to do this anymore
that's okay with me the moments of Hope people surprise us all the time patients that we didn't think could breathe do breathe patients with severe illness will go with you to the edge the will to fight we'll make it through this have why give up what's that going to do and the courage to let go I think
doing nothing is a very important consideration it really depends on what you want tonight on front line facing death in the Intensive Care Unit at
Mount sin Hospital in New York New York City a family gathers gendelina Lara Millo has been kept alive on a ventilator for the last 5 days she's not doing well she's dying very difficult we know with every major organ failing from endstage liver
disease her family is now faced with taking her off life support we have a decision to make uh one of the decisions is whether we should take the tube from the mouth and take it out does he have thoughts about that say yes okay so let me prepare you uh for what may
happen the ICU is at the Apex of life and death we give a little bit of dose of the sedative to make sure she feels no pain we have a tremendous amount of technology that prolong life but ultimately we can't overcome the patients illness in most cases they have
cancer they have kidney disease they have endstage liver disease they have these diseases that are life shortening after we remove the tube now if you look at the history of critical care we don't know how the idea of an intensive care unit was for you to come there with a life-threatening illness and respond to the treatment and get
better unfortunately what's happened is that Americans are now coming to icus to die okay I'm going to take it out okay today more Americans die in hospitals than anywhere else often after prolonged illness and many medical
interventions what modern medicine is capable of doing is almost what 20 years ago was considered science fiction essentially you can support pretty much every body system for years because you can keep their lungs breathing and keep their heart beating keep their blood pressure up and keep their blood flowing that suspended animation State
goes on forever and so the decisions at the end of life have become much more complicated for everyone involved as healthc care costs continue to escalate there is growing concern over the billions of dollars that Americans now spend each year on end of Life Care there's a tremendous pressure now to reduce
care to numbers as though there's an algorithm for every decision when you look at you know Medicare data on expenditures at end of life and what is very glibly termed waste you know 30% of All Care is waste that's the new mantra it's very hard to
know what that means and it's very hard to bring that out of Washington and into a hospital and at the bedside with a single individual facing death hi can just wasque my
hand there you go I'm going to put your head down Robert bernardini is 47 years old he had a massive stroke 2 years ago and has been living in a nursing home his cost of care is covered by Medicaid he was here 2 months ago here also with pneumonia he got better they sent him back to the nursing home and
came back in Tuesday and since then he's been on the machine when Robert came into the hospital with pneumonia he had a cardiac arrest and was resuscitated he has now been on a ventilator in the Intensive Care Unit for over a week the first two days he was listening to me cuz he would I would tell him Bobby if you hear me touch my hands and he
would but now I don't know what it is that it's not happening like that anymore nearly 95% of our patients cannot communicate because of either their underlying illness or because of the heavy sedation we're providing so what happens is is that most of the care and interventions are discussed with the healthcare decision maker who may be a family member or a health care
proxy in a perfect world the patient designates a healthcare proxy and has a discussion about what their preferences would be at the end of life but many of the patients who end up in the Intensive Care Unit those discussions have never happened the critical care doctors and this causes a tremendous amount of Burden for everybody because they now have to make life or death decisions for somebody
else so we know that he had his underlying problems right so he has U his empyema and we know he's had a stroke and uh and his underlying HIV uh as well from the standpoint of his brain uh it's unclear whether he's had long-term damage from the cardiac arrest but it does appear that uh he's waking
up the bigger problem I think right now is his lungs if we're unable to safely get him off the artificial respirator removes it to safely then the next step is what we call a tracheotomy what is this right right but there is a tremendous amount of pain and suffering that can go along with that as
well it will certainly prolong his life the question is will it improve it I don't know what to do about this should I just let him keep living in this condition I don't know I don't want him to suffer
anymore I mean I'm suffering and I know he is also I can't handle this no more but I just hope that I make the right choice I don't know I don't know I really don't know these are decisions about whether people are going to be alive or not alive and if they are alive if they're
going to be living with dependence on life supports or not or in a quality of life that may or may not be acceptable to them the risk is that somebody ends up in a position that they absolutely do not want to be in and they are very vulnerable and voiceless and cannot extricate themselves from that position
so she is very very wasted um you know very poor nutritional status she's had multiple amputations of her digits from her underlying disease Diana Reed is 31 years old and has Scleroderma a progressive disease that causes the skin to tighten and major organs to shut down You' got a patient who's in shock and a when she first came to the ICU 2 weeks ago she
was in respiratory distress and had to be intubated although Diana told doctors that she did not want to be permanently dependent on machines her family is not ready to take her off the ventilator now let's address the family situation because we did meet with them yesterday and they're coming back in today um and we have some difficult issues that we've got to address with them what we're doing is giving her
every form of support that we can for all of her organs she's getting maximum support from the respirator she's getting medication to keep her blood pressure up her kidneys really haven't been working there are clinical situations where the odds are so overwhelming that someone can survive the hospitalization in a condition that
they would find acceptable then then using this technology to support the physiology of the patient doesn't make sense does it feel and yet for almost everybody involved it feels much more difficult to stop something that's already been started um right now I want to keep her the way she is on the
respirator you want her on the respirator okay my
Martha lauraville is 86 years old and has dementia she has been intubated for 2 weeks and now her daughter nades a nurse and Shirley a physician have to decide whether to remove her from the ventilator
she loves life she's the one that always say oh I call 911 right away and even though she was not acknowledging any one we didn't know she was she knows the surrounding she lift up those two fingers and show of course we upload we were so happy about it I myself would not want to put Mom through a tra and I'm not sure at this point what benefit is that will that prolong on the life
that she's right now for one month or two months and although it is something that will be missed greatly but to me if it gets to that it's something I would accept because of compassion uh for her my sister in the other hand have a different opinion I don't want to be the one to say DN and to be the responsible for that before time I want to make sure that the help was provided and she gets
it I would not stop her from breathing I would help I would maintain her until the last minute I mean who Am Who Am I who are you we cannot decide I want to see one day at a time and take it there are four of us we will take a vote including the grandchildren and see what we comes out to and uh whatever comes out that's what we going to abide by Hi how are you nice to see you again the