We are all privileged and humbled on a daily basis to be invited into the lives of our families and patients at their most sacred and vulnerable moments and share experiences that become lifetime memories.
The Trilogy vent wean that we facilitated on Sheila Stigelman was once such experience. She was only 66 and imprisoned in a body that for years was ravaged by the neurological devastation of Amyotrophic Lateral Sclerosis.
She was tethered to a ventilator attached to her tracheostomy tube, unable to breathe spontaneously thru her nose or mouth. She had minimal use of her right arm but no other part of her body. Her diaphragms were paralyzed and only responded to the electrical impulses of a diaphragmatic pacemaker. She was a patient on our palliative service but last week made the courageous decision she no longer wanted to live this way, and transitioned to hospice.
The vent wean was Friday afternoon. Bereavement Coordinator Patty O’Shea set the tone by calling the family together in prayer and calming them with an uplifting spiritual reading. Nurse Practitioner Amy Croson knelt at the foot of the bed playing soft music on her phone while rubbing oil on the patient’s feet. Nurses Jessica Bennett and Diane Ennis started the IV, engineered the conversion from Trilogy machine to oxygen concentrator and tracheostomy collar, and meticulously prepared and labeled the morphine and Ativan filled syringes needed to achieve a level of conscious sedation that would guarantee a peaceful and dignified transition.
There was never a word spoken between any of the Crossroads staff – it didn’t need to be. As I medicated the patient and she drifted off into her final sleep, every member of her large family gathered at the bedside and made physical contact with some part of her body… maybe a finger, or a toe. Through their tears, they started to sing hymns to Sheila that she had taught all of them all as small children. Their singing gave them the strength to get thru the moment.
Once sedated, the patient’s daughter Michelle turned to me, took my hand, asked if we could deactivate the diaphragmatic pacemaker, and then stated she wanted to be the one to do it. She pressed the controller firmly with both thumbs simultaneously, the device was deactivated, Sheila never took another breath, and at 3:09 pm her heart ceased to beat.
I wish every member of our hospice family could have been present to experience this solemn and sacred moment with us. It was hospice at it’s very best, and a moment I will never forget.
My compliments to the entire team that assisted me, and to all those in the office who helped us to get this planned through the week.
Walter George, MD
Crossroads Hospice & Palliative Care
Senior Vice President Physician Training & Services