I have often seen family members say goodbye to a dying patient – there are many different ways to do it. But that the wife, full of desperation, lay in bed with her seriously ill husband and called out “No, no, don’t leave me alone” has only happened once so far.
The patient had a pre-existing condition and had been to us several times. This time he was already out of his mind on the normal ward, his prognosis was dire – that means that his condition could not improve and that his death was expected. However, his wife insisted that the doctors should do whatever they could to keep him alive. So he came to us in intensive care. He quickly became in need of resuscitation – his heart started again. This was followed by intubation, a ventilator and all sorts of medication to somehow keep his circulation going.
It was a classic case of over-treatment at the end of life: life is preserved with all the means available to medicine – although it is clear that the person concerned will die, that his body simply cannot take it anymore. Medicine only delays death, often in a painful or undignified way.
Those are harsh words, I realize that. But anyone who works in my profession and experiences such cases again and again knows that it is the truth.
Intensive care specialist Pola Gülberg from the Ebersberger district clinic.
(Photo: Peter Hinz-Rosin)
After we resuscitated him a second time and the wife continued to ask us not to switch anything off, I said to her as sensitively as possible: “Take a close look at your husband – he’s gone a long time ago,” she replied: ” But he’s still breathing.” But it was the ventilator that was breathing – not her husband.
The woman’s reaction is understandable, after all it was about a loved one. She couldn’t accept the situation. It is all the more important for patients who are seriously ill to think about this when the diagnosis is made: What does it mean when the doctors everything should do to preserve life? What should happen if a fight becomes hopeless? And then these wishes should be recorded in a living will.
I also experienced what a relief that can be for those involved: Again it was a man, he had made precise decisions about which treatments he wanted and which he refused. And his daughter should have the last word. At first she had said that she didn’t know how to decide now. Then I took her hands and said: “You know, your father gave you a huge present, he put everything in writing – now it’s up to you whether his will is enforced.” A great burden was lifted from my patient’s daughter’s shoulders when she realized this. In the case of her father, there was no over-treatment, he was able to die peacefully in the presence of his loved ones.
Pola Gülberg is an intensive care nurse. In this column, the 38-year-old talks about her work at the district clinic in Ebersberg every week. The collected texts are below sueddeutsche.de/thema/Auf Station to find.