"We Can't Kill Your Mother" and Other Stories of Intensive Care
by Lawrence Martin, M.D.
Table of Contents

NOTE: "We Can't Kill Your Mother" and Other Stories of Intensive Care can be downloaded in its entirety as an e-book from 1st Books Library ($4.95). The book can also be ordered in trade paperback format for $13.50. For purchasing the e-book or print versions, please go to 1st Books Library and enter part of the book's title or the author in their search engine. Below are the first few paragraphs of "WE CAN'T KILL YOUR MOTHER!"

As an intensive care doctor I've dealt with many ethical dilemmas, most involving decisions to start or stop artificial ventilation. One of the most difficult was that of Mrs. Virginia Tyson, an 80-year-old nursing home resident admitted to the medical intensive care unit April 27, 1989.

A month earlier she had fallen and fractured her right hip. She underwent a hip repair and returned to the nursing home, but had not walked since. Additional diagnoses were rheumatoid arthritis, emphysema, and cardiac disease. Dehydration, on top of her bed-confined state and chronic lung disease, led to acute respiratory failure. Shortly after arrival to MICU we had to place an endotracheal tube through her mouth and begin artificial ventilation.

The severity of her condition made it impossible to remove the tube and discontinue the machine ventilation. Although her acute medical problems were eventually corrected she could not be disconnected from the ventilator; each attempt led to severe shortness of breath. On May 4 she underwent tracheostomy, a procedure that places a short plastic breathing tube through an opening in the neck, allowing the larger and more uncomfortable mouth tube to be removed.

With tracheostomy a patient can eat while receiving artificial ventilation. The 'trach' tube is also much easier to care for than a mouth tube, and can remain in place indefinitely.

Mrs. Tyson's need for artificial ventilation did not improve after tracheostomy. She simply did not have the strength to sustain breathing without the machine.

Her closest family was two daughters, one of whom lived in a nearby state and the other far away, in Seattle. The nearby daughter stayed in town and visited her mother daily, and was in phone contact with her sister.