This poor 77 year old guy showed up in the SICU one day as a transfer from some LTAC facility. He'd been in a car accident a couple of years ago and suffered anoxic brain injury, rendering him in a persistent vegetative state. Trached and pegged, and curled up tense and taut from contractures, he looked like the quintessential gork. One of his legs had been lopped off because of injuries sustained during the initial trauma. He was unshaven and gaunt-faced, temples completely wasted on both sides; a skeleton covered by skin. We were called because he wasn't tolerating his tube feeds and had developed abdominal distention. A CT scan suggested a distal small bowel obstruction and a possible cecal mass as the underlying etiology.
Normally in these situations, you explore the guy in the OR and resect the tumor. Or maybe colonoscopy first, if he isn't too obstructed. But this guy was merely existing. There was no life there. Cells and fluids and proteins supported by machines, maintaining a facade of humanity. We all knew better, but the family was entirely unreasonable. Multiple conferences with doctors couldn't dissuade them from a desire to "have everything done". They asked about transfer to the downtown medical mecca, if nobody wanted to operate on him at our hospital. Frankly, it seemed unethical to me to slice open this withered apparition. I figured reason would eventually set in, but no. The other day, life flight whisked him off to the downtown mecca. The internist at our hospital who arranged the transfer (reluctantly) told me that the surgeon accepting the patient told him that "we know how to do diverting colostomies at this institution." Just outrageous pompousness. First of all, if he'd looked at the films, he'd realize a colostomy isn't going to do anything about a cecal mass obstructing the ileum. Second, I also know how to do diverting procedures; it isn't hard. The hard part is deciding when to do nothing. Oh well.... I suppose when you're dealing with difficult family members, sometimes the best option is to give them what they want, i.e. second opinions from the "smart doctors" downtown.