A Question of Life and Death

Yankee, September 2001
National Magazine Award — 2002 Finalist

When technology can keep  almost anyone alive—at least technically alive—it is increasingly difficult for patients, their families,  and doctors to know  where to draw the  line. In Boston, at  the leading edge  of medicine and ethics, here’s who is helping them decide.

The meeting begins usually at one in the afternoon, always on the last Wednesday of the month. Attendance is not required, though that seems not to matter—the room is always full. It is a drab, medium-size conference room, with a small corner window and an oblong table at its center, at the north end of the Intensive Care Unit (ICU) at Massachusetts General Hospital in Boston—one of several hubs in what is probably the finest medical complex in the world. The nurses and doctors who attend are in their thirties and early forties, a mixed lot of men and women in green hospital scrubs, khaki and flannel, sneakers and street shoes, some in lab coats, some without.

A few have come with bottles of water, others with Styrofoam cups of tea.

At one end sits the group’s leader, a brown-haired woman in street clothes, a little older than the rest. In front of her on the table is a blue three-ring binder, opened to a list of names. This is known by the group as the Allen Street log—named for the morgue on Allen Street, where the bodies go when they leave.

In an average month, 15 patients will have left here for the morgue. There is almost nothing that can be said about them generally: Most, but not all, were old; they died of cancer, heart disease, renal failure, head trauma, a host of other things; some died alone or only with nurses, others with loved ones by their beds. Most went peacefully and without pain—“a good death” is what is said about those. One or two, perhaps, did not. It is for these—very literally in their memories, to create an “acoustic mirror” of what went wrong—that the Wednesday afternoon meetings are held.

They begin always the same way: with a reading by the group’s leader of the list of the month’s dead. She reads slowly, pausing and scanning the room between names. It is a solemn process. There is the sense, to an outsider, of being witness to something very private and profound.

The first four or five names are apt to pass without comment—sometimes a head shake, other times a smile. Then a name will be read and someone around the table will speak: “That one didn’t have to happen that way.”

Then will come the details. They are never the same from telling to telling, except in the broad picture they paint—of patients kept alive through massive arsenals of medical technology that defeat every effort of their organs to shut down. And though the particulars differ from Wednesday to Wednesday, over the course of any six or eight meetings you would hear all the commonest tales: of ventilators that breathe for dead lungs; vasopressor drugs, dripped through IVs, that stimulate blood pressure when there is no longer a working heart; dialysis machines that run the blood through purging filters long after the kidneys have shut down; a chemical mix known as TPN (total parenteral nutrition) that takes over the jobs of the stomach and bowel. You would hear about fingers and toes turned black from necrosis while the body still technically lived; of massive doses of numbing opiates, and of neuromuscular blockers that induce total paralysis in patients who might otherwise tug at their tubes.

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The full story (as well as sixteen others) is available in the collection, ‘The Grifter, The Poet, and The Runaway Train’ (click title to access the book).