One more cuddle

I'm taking care of a patient right now in a very unfortunate situation. He's 70 years old, and is a university professor. He was recently on a cruise with his lovely wife of 30+ years somewhere in the Caribbean when he started developing neurologic symptoms, one-sided weakness, headaches, etc. He was evaluated and found to have a huge bleed in his head that was compressing his brain. He underwent surgery somewhere out in the tropics in which they removed part of his skull to evacuate the blood and relieve the pressure on his brain. After a long stay in a small hospital on some island, he was transferred to our ICU. He spent some time there, and then when it appeared that he was stable, he was transferred to general internal medicine on my team. I went to see him and he was laying down in bed with his tracheostomy tube and with his eyes closed. At first, he looks like a vegetable, not really responding to anything, can't move any of his extremities, but when I called his name he did open his eyes and move his eyes to look at me. I asked him some questions and he very distinctly nodded yes or shook his head no. I've worked with comatose patients in the past, but he was different. Some patients I go to see in the morning and no matter what I do, they make no response. With him though, he hears you. He knows you're there. You can see it in his eyes. Other patients lay there on the bed--just bodies, but this man still had a bit of "him" left, not just his body. Some days are better than others and he responds more, other days he just opens his eyes and stares, just breathing and staring. I came into his room one day and met his wife. She is a beautiful woman, also a professor, and she was very kind and seemed to be dealing with the situation incredibly well. She had been watching her husband in this state for almost a month by this time, but every day she came to him, chose some songs on his i-pod and put it right up next to his ear. She told him about her day, their daughters, what was happening with her at work. I spent some time talking to her and getting to know her a little bit and then talking about what the plan would be with him. She asked me about his condition aside from the brain injury. "Other than that, he's actually very stable," I told her. "His heart is working very well, his lungs are clear and he's completely recovered from the pneumonia. His kidneys weren't working very well about a week ago, but they've also recovered completely and are doing fine." She paused and thought for a bit and said, "You know, we've been married over 30 years and it's been a really great marriage. But we've been getting older and as we've seen our friends have things happen to them we've started talking more about what we would want to take place if something were to happen to us and how we would want to or not want to live. And even though this is the hardest thing I could ever imagine doing, I'm going to try to honor that and just keep trying to do what he would done to him, and I know he wouldn't want to live like this. I know this seems to you like I'm making this decision pretty quickly, but remember that you just met him. I've been with him in this condition for the past month. And I just know he wouldn't want to lie here in bed doing nothing but breathing, not comprehending the world around him. He just wouldn't want it." As she's talking she's stroking his arm and talking to him intermittently, "Right sweetie? You would do the same for me wouldn't you." I listened to all this listening as the doctor and yet hearing like a person with family members she loves and imagining what it would be like to have to watch your love having life slowly taken from him. I explained to her all the different options for end-of-life care, and she listened and made decisions commenting each time with "that's what he would want." I shook her hand and said, "I'm so sorry you're in this terrible situation. Is there anything else I can do for you?" She paused and with a small smile and tears running down her face she said "Dr. Evenson, at some point, I need you to get someone to help me reposition him and get rid of all these tubes so I can cuddle with him just one more time. I want my time with him. There are just some things that have to happen before this man leaves my life. I know I'm asking for your help, but actually I'm just telling you this is going to happen." I gave her a hug and with tears running down my face said "I'm sure we can do that for you. We would love to help you have that."