Dying at home

Another one for the books. When I was on call this past weekend I was involved in an extubation of a younger guy; 23 years old and a gun shot wound in the back of his head. He'd been at our hospital for 3 weeks on a breathing machine, waiting to see if he'd become brain dead. This is a case you'd say, unfortunately he didn't progress to brain death. He was trapped- not brain dead, but in a persistent vegetative state. Enough damage had been done from the bullet, that he was guaranteed never to wake up. Ironically, his 14 year old cousin had died at our hospital 6 months earlier with a gun shot wound. Having watched the ordeal his cousin went though, our patient was very vocal to family and friends that he'd never want to be alive if it was hooked to machines.

After 3 weeks in the ICU, it was time for the family to honor his wishes and take out the breathing tube. Over 30 people assembled after church sunday to meet one last time with us and give the final okay. We extubated him a little later, and not surprisingly, he began to breath on his own. As healthy and young as he was, it became clear that it would be days before his body actually shut down. His fiance', with 2 kids at home, was adamant she wanted to take him home to care for him these last days. We reluctantly made arrangements for this, and things started getting messy.

Police began calling. Evidently, there was suspicion that a family member was involved with his shooting. In fact, the bullet was still lodged in his brain, and would need to be extracted at autopsy for evidence. There was worry that the family wanted to take him home to die, to avoid the autopsy. (Destroy the body to protect the family?) We even had to have a last minute meeting with our lawyers on the legality of sending him home. Then this patient's fiance' started asking questions about sperm donation, wondering if it was possible to somehow extract some sperm for later use. (The answer legally is no, because he can't give consent). Just when we finally had everything arranged, the hospice home team started to fuss. It was too late in the day, they said, to go to this fiancé's neighborhood to meet him on his transfer from the hospital. The nurses worried, they'd be the next gun shot victim in our hospital.

What can I say? Isn't helping people die at home supposed to be easier?