Just a minute before, I had been in surgery checking on the status of a patient who was undergoing an exploratory laparotomy.  She had been doing OK, but deteriorated relatively quickly that afternoon while still in the hospital recuperating from an unrelated operation.  The anesthesiologist popped out of the room to tell me what the initial findings looked like.  It was not good.  That’s when I went to speak to the family that I knew so well.  I had cared for all of them for a very long time.

I walked out of the operating room, leaned down and looked into the husband’s deep blue eyes.  I then spoke words that no man wants to hear.  “All of her small bowel and about half of her colon is dead.  There is nothing that can be done.  She is going to die. The only question is how.  What do you want to do?”  I inquired as gently as I could.

He looked at me with those big beautiful blue eyes incredulously as he began to sob and asked, “What do you mean?  I don’t know what to do.” he declared matter of factly.  He then said the most horrible thing.  “You decide.”

How is it I dare to ask someone to make such a decision?  … How presumptive.  How can a husband who knows little if anything about science and medicine, assimilate the data delivered so abruptly and then decide that it is time to provide comfort only measures to the wife he has loved for 57 years?  It is unthinkable.  He cannot do it.

Slowly I made my way back to the operating room.  I felt tears begin to slowly collect in my eyes and tried my best to control the expression of those unwanted intruders we call emotions.  I entered the operating room and nodded to the anesthesiologist, the general surgeon and the vascular surgeon and the rest of the team.  I broke the silence.  “I would like for you to run the bowel for me and let me see it myself.”

“Are you sure?”

“Yes.  I have to know for myself. I need to see it.”  I thought that if I must make this decision for this man, I must know with my own blue eyes that it is true and right.  Like many decisions we make in medicine, I knew that I would live with this one a long time.

Methodically, the surgeon started at the duodenum and proceeded through the jejunum, ileum and right hemicolon demonstrating the profuse, necrotic, ischemic changes that were obvious and throughout.  Whatever collateral circulation had been perfusing her bowel had been apparently unalterably compromised.  I asked the vascular surgeon if he agreed.  He did.  We were all in concurrence.  My sad blue eyes agreed.

Even for an otolaryngologist with only one year of general surgery, I knew the situation was hopeless.  Yet there was an unmistakable voice deep inside me that cried out, “Do everything you can.”  That part was my heart. My humanity was oozing out, crying to be heard.  I am certain it is the voice that family members hear when confronted with these types of decisions.

I swallowed hard and asked,  “Is it possible to close her up and take her to the ICU to give everyone a chance to say goodbye.”

“Of course.” they said.

So I decided.

And that is what happened.  They closed her up and took my mom to the ICU on the ventilator.  Then a woman loved more than any words on any page could convey had the life slowly run out of her.   Surrounded by her family including my sister and my dad, the man with the big blue eyes …. we said goodbye, and she died.

Shawn C. Jones is a otolaryngologist.

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