That is the term that was used to describe bacterial pneumonia before the introduction of antibiotics. At that time pneumonia was considered a good way to die. Though mostly viewed as a blessing, the aggressive treatment used to treat pneumonia in elderly patients today can also be a curse.
Modern medicine offers a multitude of ways to keep alive persons who in the past would have passed to God with speed and grace. Now more often than not, elderly patients are hospitalized and in the process traumatized in the name of progress. This past weekend my family experienced this phenomenon first hand when my dad experienced the rapid onset of an acute bacterial pneumonia.
A call came to me from the nursing home late in the afternoon on Saturday informing me that my dad was having difficulty breathing. The oxygen saturation level of his blood was 80-85, readings of 96-100 are considered normal. The doctor was called and the order he gave was to 911 him to the hospital. I was in Nebraska, so quickly called my sister to inform her that dad was on his way to United. Waiting for an update from my sisters was torture. I was convinced that dad would die without my being given the opportunity to say a final goodbye.
According to my sisters who arrived at the ER shortly after my dad, the scene was quite chaotic. Multiple caregivers were at work on my dad, starting IV lines, taking blood and administering oxygen. My dad who is 88 and has dementia had a look of utter terror in his eyes. The hospital staff were following an aggressive protocol that was recently enacted to treat pneumonia. Without waiting for chest x-ray results or blood cultures, they started dad on 4 different antibiotics. The doctors shared with my sister that the combination of antibiotics had the potential to lower my dads blood pressure to dangerous levels. The doctors asked my sisters how aggressively they should treat my dad. It was via speaker phone with my sisters from 400 miles away that I began to weigh the pros and cons of further treatment.
My mother was always very clear about her wishes regarding medical treatment. We have had fewer conversations with my dad regarding end of life decisions and due to his dementia he is no longer able to guide our decisions. The conversation centered on comfort versus the introduction of more invasive medical procedures that would be necessary to treat a low blood pressure. The introduction of a central line would be needed to administer the medication that would raise his BP and keep him alive. This procedure would then necessitate an ICU admission which we feared would further confuse and traumatize my dad. With input from my brother and conversations focusing on quality versus quantity, we decided against any additional treatments. This meant that if dad’s BP dropped, we would let him go.
I slept fitfully Saturday night as I waited for that dreaded phone to ring. To my delight the call never came. In the morning I received the news that dad had responded well to the antibiotics and was on the road to recovery. Two days later he was back in his room at the nursing home. This is not the last time my sisters and I will be put in this type of situation. Dad’s pneumonia was caused by aspiration, which makes it likely that the same sceario will recur. If this is the case the logical question from the medical team will likely be; “Do we continue to treat with antibiotics or keep him comfortable in the nursing home?”
Many older adults endure countless days in the ICU, multiple diagnostic procedures, many of which are invasive, and endless treatments in the quest to prolong their lives even if it will only result in a few more months, weeks or in some cases days. As a result, the dying process has moved out of the familiar and comfortable environment of the home and into the sterile, cold environment of a hospital. I do not wish this for my dad and will do everything in my power to insure that he meets God surrounded by beautiful music and the people that love him.
P.S. It feels good to be back to my blog site.