“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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Ouchi K. A Decision With Love. JAMA Neurol. 2021;78(10):1175–1176. doi:10.1001/jamaneurol.2021.2758
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