Lisa Baker at
Samaritan Hospital

 

The end

FOR SOMEONE WHO HAD HAD DIABETES  for 30 years, Lisa's kidneys were in remarkably good condition. A common complication of the disease is damage to the organs that filter waste from the blood. Lisa's kidneys, though, had continued to function well and tests done just after she was admitted to Samaritan showed that both her creatinine and BUN (blood urea nitrogen) levels were close to the normal range.

But that had changed by the third week following her collapse.  A nephroligist, Dr. Leslie Goldstein – one of a half-dozen specialists who were treating Lisa – told me her kidney function was declining, and that he thought that by the middle of the following week she would be on dialysis.

And Dr. Goldstein said he had no doubt that the change was the result of the near-zero glucose level that had occurred on the night of November 11.

Dr. David Strumpf, a pulmonary specialist who worked in Samaritan's CCU, explained that the damage was not limited to Lisa's kidneys.  All her vital organs were affected, he said, and the result was a downward spiral as the decline of one put stress on each of the others.

Dr. Strumpf also said he believed the damage was the direct result of the lack of glucose that had occurred on the hospital's fourth floor on the night of November 11.

On the Friday, at my request, a third EEG was done.  After it was completed the neurologist said it showed even less brain activity than had been found by the second one.  He also said Lisa lacked the oculocephalic, or 'doll's eyes' reflex.  The absence of this reflex, he said, strongly indicated that the brain stem was damaged, which was consistent with her inability to breathe on her own.  I also noticed that Lisa's arms were straight at her sides, with the palms turned downward and out instead of facing the body, a condition I was told is known as decerebrate posturing, a strong indication of brain-stem damage.

I discussed the situation with Lisa’s brother.  He had been in contact with Lisa’s two sisters, and with her mother and father.  All except her father agreed that Lisa would not wish to be kept living on life support. Lisa also had said repeatedly she didn’t even want to be on dialysis.  Only her father had continued to believe that his youngest child might recover.

But by the weekend of November 29/30 he had accepted that even if Lisa did not die from organ failure, she was never again going to be Lisa.  He accepted what she had also told him: that she did not want to be a vegetable kept alive by a machine.


IN THE EARLY AFTERNOON OF DECEMBER 1, Lisa's brother and one of her sisters met me at the hospital.  We were there to discuss  the situation with Dr. Strumpf.  The hospital wanted us to sign a statement saying Lisa had told us she would not want to remain on life support if there was little hope of regaining consciousness, and that we were not opposed to removing the respirator. The statement was clearly intended to protect the hospital from a legal claim.

As the statement was being drafted, I recalled how just a couple of months earlier there had been a story on TV about Terri Shiavo, the Florida woman whose husband was trying to take her off the feeding tube she had been on since she had become unresponsive after a heart attack in 1990.  I asked Lisa what she would want me to do if she were to be on life support with no hope of recovery.

"That's not going to happen to me," she said.

But what if it does, I said.  By then, you won't be able make the decision.

"I wouldn't want to be kept alive by a machine," she said.  Then after a short time, she turned to me and said: "Promise me you won't let them keep me alive like that."

I told her we should get the proper form signed and witnessed.  But it was put aside and had not been completed when Lisa went to Samaritan Hospital on November 6.
*****
After the statement was signed, Dr. Strumpf  told us he was disturbed by what had happened on the fourth floor three weeks earlier.

“I was not involved with it,” he said.  “But for your own peace of mind, I hope you folks will investigate.  This should not have happened.  Something went very wrong up there.”
*****

That afternoon Lisa's respirator was removed.  At 5:37 p.m. on December 2, 2003 and with me at her side, she died.

 

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