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  • Peace
  • Guang-Shing Cheng (bio)

The old woman grasped at the mask, struggling against the ties that bound her hands to the sides of the bed. Her droopy eyes were open, but I don't know if she registered my presence. I arrived just as she was extubated from the ventilator, which had been part of her life support for the past three weeks. The pneumonia that had originally landed her in the intensive care unit had resolved days ago, and it had taken doctors just as long to wean her from the ventilator. Now she was still getting help from the BiPAP machine via a mask that forcefully blew air into her nose and mouth.

"Granny, keep your hands down! Don't pull at the mask, it is helping you breathe," a young nurse yelled into her ear. Her frantic movements, her thrashing head, told us that she wasn't listening. I didn't need to hear her voice a complaint to know that she was uncomfortable, whether from difficulty breathing, the tight-fitting contraption, or both.

This old woman was like many of the elderly patients that I have encountered, but different in two major ways: she was ninety-eight-years-old, and she was my grandmother. She'd beaten the odds many times-she had lived through war and political upheaval, outlived her husband and six of their seven children, and survived a broken hip in her eighties. She didn't take any chronic medications. She was frail but in good spirits. Although she could not remember how to ride the elevator to her apartment, she knew the birthdates and whereabouts of all her great-grandchildren. She lived with cousins who took care of her full time. When my cousin called to tell me that she was hospitalized with pneumonia in Taipei, Taiwan, I thought, She's had a good life. Let her go in peace.

Peace-by this I mean a comfortable death, pain-free and natural, without all the needles, monitors, tubes, and infusions that make up the armamentarium of modern medicine. I hoped that the technology I employ as a critical care physician to keep people alive-or, one might argue, to prolong death-would not be used on my grandmother. She was lucky enough to make it to this advanced age without medications, and to be allowed to die that way was unquestionably the respectful and dignified way to go.

My cousins and my uncle didn't see it this way. They couldn't acknowledge that she was near the end of her life; they wanted her to reach the century mark so venerated in Asian cultures. For them, modern medicine existed to keep people alive as long as possible, without regard to any suffering that came with it.

In the days that followed, they allowed her to end up on the ventilator, contrary to my entreaties from half a world away. "Please, please, at least don't make her undergo CPR if she codes," I asked. I gnashed my teeth every time I spoke to them. I could not sleep knowing that I could do nothing to prevent her from undergoing the same painful treatments that I had seen many patients experience, only to succumb to death. I was angry at the physicians for allowing this to happen, for not dissuading my family from such a course, and for offering such aggressive management in the first place.

I complained about the situation to my colleagues. They knew exactly what I was talking about. They all shook their heads in sympathy and agreed that she should be left alone, especially at her age.

My clinical mentor had a different view. "How do you know that she wouldn't want to go through this, just to live one more day? Her life before she got sick wasn't so terrible." It was true: I did not know exactly what my grandmother wanted. I assumed that she wouldn't want to go through this. It wasn't just that she was frail or that she'd complained about the hospital food and the discomfort of foley catheters. I assumed that she would accept her death...

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