I chose dignity

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By Richard P. Holm, MD

An elderly late-80s gentleman came into the emergency room unconscious with the diagnosis of a new stroke. The CT of the head indicated there was no bleeding into or around the brain, indicating he had a blood clot, not a bleed that caused the acute brain injury.

Symptoms had begun six hours earlier, but the patient and his family just didn’t get to the emergency room in time to try a clot-busting medication that can sometimes save the brain. The family and I had a long talk. I discovered that the patient had been living alone in his home of 50 years, still visiting a nursing home every day to see his wife who had severe Alzheimer’s Disease.

He had an advanced directive of which his family was aware. He had enjoyed a good life, his financial affairs were in order, and he did not want resuscitation if it was required. I remember a previous encounter with him where he told me, “That would be an easy way to go, so do not resuscitate. And whatever happens, no feeding tubes unless I have a reasonable chance of returning to a normal life, where I would know what’s going on.”

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