We had an interesting case in the ICU. The man is 350 pounds. He was mugged and has a metal plate in his head, he is severely alcoholic, and he's had a stroke. Whenever he's been conscious over the last several weeks, he's been extremely confused and combative. He's been taken off the ventilator twice (during which he's combative again), and put back on. His respiratory status is crappy, probably from a knock-out combo of long-term confusion, sedation, pneumonia, obesity (obstructing the trachea), and probably alcohol dementia. He's going to need a tracheostomy. He'll also need a feeding tube put in to maintain his nutrition. But what happens to this patient in the long run? When we wake him up, is he going to fight with people forever? Where will he go?
He has some siblings. One is even taller and bigger than my patient. He has schizophrenia. He has an enormous fairy-tale beard. He shouts things randomly. He started exclaiming about peanuts one day. I passed by him and he shouted "did you see that ***king faggot!?!" at me, and then turned around, trundled off, and shouted the same thing at the wall. He curses randomly and calls the African-American nurses "monkeys". He jumps out of the room shouting that he heard people talking about him. Another brother, who always accompanies him, is shorter and walks with a cane. He had a stroke and has some difficulty talking and understanding things. He seems meekly aware of his mentally unstable brother, and mumbles things like "You're just hearing things," "They're just trying to take care of him," and "Don't get us kicked out of here again..."
These two drive themselves to and from the hospital, which somewhat boggles the mind.
They have a sister who takes care of them. She is considered the only legitimate decision-maker. But: she is now in a nursing home. The patient's doctor had a fun time trying to call her to do a phone-consent for the tracheostomy and g-tube.
I don't know where I'm going with this story. I guess some family situations are just startling. I really feel bad for them. I don't know what would correct it, though. Alcohol surely didn't help; being overweight surely didn't help; maybe they could've lived healthier and avoided the strokes; but you probably can't avoid the schizophrenia. Did any of them have children? Why are these four people wandering the earth, essentially on their own, in this state?
UPDATE: I posted twice more about this sad case:
Part 2: My First Brain Death?