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On the Brain
August 23, 2021

A Decision With Love

Author Affiliations
  • 1Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
  • 2Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
  • 3Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
JAMA Neurol. 2021;78(10):1175-1176. doi:10.1001/jamaneurol.2021.2758

“Would your father want trach and peg at age 70?” A well-meaning, compassionate physician asked after sitting me down. I did not know anybody who wanted a trach and peg (tracheostomy and percutaneous endoscopic gastrostomy). When I asked about an alternative, the physician’s quiet answer was hospice. Knowing this answer before hearing it, I was still confused as I could not grasp what it means for my father to die.

After an aneurysmal subarachnoid hemorrhage 4 weeks previously, my father was still in a coma. Miraculously, his aneurysm rupture was witnessed by friends. He was taken immediately to a nearby emergency department in minutes, where he had a diagnosis, intubation, external ventricular drainage, and definitive coiling within a few hours without any brain herniation or ischemia. However, his clinical course was complicated with cerebral vasospasms and a new subdural hemorrhage from the drain requiring emergency craniotomy. Given that he is 70 years old and in a coma for 4 weeks, I can see why this physician is worried and trying to help me see the potential for a very poor prognosis while asking me to make a decision regarding a trach and peg placement.

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    1 Comment for this article
    Ask The Family What Dad Would Want
    Gerald Steiman, MD | Mount Carmel East
    I have found it helpful to ask the family, “If your father was listening to everything we said, what would he choose?” The family has less difficulty if the decision is not left to them.