By Kathryn Butler, TGC.
I drew a breath and said a quick prayer as I stepped into the last room of the ICU. There in the bed, my sickest patient hovered in that shadowy existence between life and death. Bruises mottled his arms as blood leached into his tissues. Although a formidable array of medical machinery hummed around him, his organ function continued to dwindle. He was dying.
In the dim light, I barely discerned the silvery lines staining his wife’s cheeks as she sat beside him. She’d been crying for a while. “He’s the one who usually helps me with hard things like this,” she said. Finally, she looked at me, her expression weary and pleading. “I wish God would just tell me what to do.”
Crushing Dilemmas
Such pleas echo in the rooms of every hospital, as the landscape of death and dying has shifted dramatically over the past 50 years. A century ago, almost 90 percent of people died at home, among families, in the communities that helped shape their lives. Dying was something familiar and recognizable, tied to its spiritual significance.
Now, almost 60 percent of Americans still voice a desire to die at home, but only half of that number do. The majority of us now draw our final breaths in hospitals and long-term care facilities, and up to 29 percent of Medicare beneficiaries die in an ICU.
The medicalization of dying often thrusts loved ones into harrowing ordeals. Up to 70 percent of people can’t vouch for themselves at the end of life, and in such cases, the burden of decision-making falls to loved ones already reeling with fear and grief. The toll on families is heavy; loved ones often suffer from depression, anxiety, and even PTSD for up to a year after making end-of-life decisions.