Many years ago when I was an EP in Florida my grandfather resided in a nursing home. He’d had a great life first as a jeweler then as a retiree playing golf, swimming in the gulf, and spending time with his family. But, because of dementia, at the age of 90, he had to be placed in a nursing home. It worsened to the point that he no longer recognized family but someone visited almost every day, helped him eat, and talked to him. We loved him and we were glad to repay him for all he had done for us.
About a year after he had been there I received a call from my mom saying I needed to call my Grandfather’s doctor, which I did. What I heard was that “he has a fever and pneumonia and has to go to the hospital.” I said, No, he would be happier to stay in the nursing facility and die peacefully. The well-meaning doc said that “OK, we will start antibiotics”. I said that was not necessary, we want him to be comfortable. I knew that is what my Grandfather would have wanted if he could tell us. The doctor knew this was best and agreed.
This was 25 years ago but I remember that our family sat with my Grandfather around the clock for about 24 hours until he peacefully passed away. I think it was Osler who called pneumonia the friend of the aged. It rang true. It takes extra time with families to ascertain what their loved one would really want which may often be peace. When the situation presents itself I try and take the extra time to talk with family of patients that are elderly and demented.
On a number of occasions I have kept patients comfortable and let them die peacefully in the ED with family around, admitted them to the hospital with that understanding, or sent them back to a nursing facility with an order for prn morphine. Once you go to that extra trouble to “tee it up,” the admitting hospitalist and nursing facilities are quite agreeable and the families have thanked me for helping them do what their loved one would want–a peaceful death with dignity.
–Alan Jon Smally, MD