TOPICS > Health

Frontline Examines Difficulty, Importance of End-of-Life Decisions

November 23, 2010 at 6:16 PM EST
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The latest Frontline -- airing Tuesday on many PBS stations -- confronts the complicated end-of-life decisions that patients, families and doctors must face. This excerpt shows the tough decision-making surrounding one patient's grim prognosis at the Mount Sinai Medical Center intensive care unit in New York City.
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TRANSCRIPT

JUDY WOODRUFF: Finally tonight: an inside look at complicated end- of-life decisions. Tonight’s edition of “Frontline” follows doctors, patients and families at the Mount Sinai Hospital intensive care unit in New York City.

One case they profiled was that of Norman Smellie. He had spent two months in the hospital and had suffered liver failure after a bone marrow transplant.

In this excerpt, Smellie’s doctors and family grapple with his grim prognosis.

DR. JUDITH NELSON, Mount Sinai Hospital Intensive Care Unit: Nobody wants to die. Nobody wants to die. And, at the same time, nobody wants to die badly. And that is my job.

My job is to try to prevent people from dying, if there’s a possible way to do it, that will preserve a quality of life that’s acceptable to them, but, if they can’t go on, to try to make the death a good death.

Were you here during the night? OK.

Good morning, Norman. We’re going on just listen to your chest and do a few other things on the exam. And we will try very hard not to hurt in any way.

Can you just open your eyes up a little bit for me and look all the way up?

NARRATOR: It’s been two days since Norman Smellie was brought to the ICU from the Bone Marrow Transplant Unit. And he has continued to get worse.

DR. JUDITH NELSON: All right, don’t push too hard, because you have got pain in the side.

NARRATOR: So, Dr. Nelson wants to meet with Norman’s family and Dr. Osman to discuss his prognosis.

DR. KEREN OSMAN, Mount Sinai Hospital Bone Marrow Transplant Unit: He has a lot of medical problems, as you know, and doesn’t have terrific counts. He got grade-four (INAUDIBLE) disease of the bowel, which I have yet to see somebody recover from and live through. He also has CMV (ph). So, he has a lot, a lot of problems.

You know, I had many conversations with Norman myself about his prognosis and what would happen and what he wanted. But you can have a lot of conversations about these things. But I think, when the moments come, I don’t think that anybody can be completely prepared for what it’s really all about.

DOCTOR: Hi. I’m Dr. Semedren (ph).

So, you know he had the biopsy the other night. It looks like that is the GBHD (ph).

PHYLLIS HUNTE, Patient’s Sister and Health Care Proxy: Look, I have a question. And I would like a straight answer. Is my brother dying? I think I need — I need a straight answer.

DR. JUDITH NELSON: What do you think, Phyllis (ph)? What do you think?

I mean, I think we can say what we think, but what is your gut feeling about it?

PHYLLIS HUNTE: My gut feeling is that this — there’s not going to be a positive outcome here. OK? There’s — I don’t see Norman walking out of this hospital.

DR. JUDITH NELSON: I think you’re right, Phyllis. I think he’s dying. And we have trouble picturing him leaving the hospital also. I think he has too many problems, based on what Dr. Osman is telling me and what we have observed in the ICU. And they’re all playing against each other in a very bad way.

WOMAN: He’s been telling me he doesn’t want anything.

DR. JUDITH NELSON: That’s why I remember when I asked him if he’s — yes.

WOMAN: Yes. He doesn’t want anything for — well, since he was upstairs.

PHYLLIS HUNTE: Unfortunately, for me then, when I come, he never says any of those things to me. I just don’t want him to be in pain.

DR. KEREN OSMAN: He’s not going to be in pain. He is not going to be in pain.

DR. JUDITH NELSON: The uncertainty is the most disturbing part of the decision-making. And the availability of the therapies has created this fiction that we can orchestrate this, one way or the other, when the truth of it is that, for all of this magnificent technology, the underlying illness and the medical condition of the patients are far and away the most important factors in determining the outcome.

But it feels like, when you have the technology available, that your decisions to use or not use it are like the decisions to allow life or not allow life. And that’s not a position that any of us wants to be in.

JUDY WOODRUFF: Norman Smellie’s family ultimately decided to stop treatment. He died soon after of complications from his transplant. “Facing Death” can be seen on most PBS stations tonight.