The buzzword that has Americans up in a roar these days is healthcare reform. As Barack Obama has put healthcare reform first and foremost on the list of changes that Americans can look forward to, Americans are fighting back fiercely. One of the most recent ideas brought forward is the End-Of-Life Act. When Obama spoke of end-of-life care for individuals 75 and older that have cancer what people heard was, if you get cancer at 75 years or older, your only option will be death. But were Americans really listening? I’m not really sure what the End-of-Life Act entails but as I am making my way through the ICU, rounding on all of the patients at the beginning of my shift, what I am sure of is that America needs something,

Room one lies there severely malnourished and cadaverous, moaning in pain. His respirations are labored and quick. His once 160-pound body is down to a skeletal 110. His skin, shrunken to his body, lies on his bones as if draped like a blanket. He is pale and grey and his lower extremities are mottled up to his largely distended and firm abdomen. I peer in half expecting an alien’s hand to push through his gut. He is only 41 years old but dying of metastatic pancreatic cancer. The cancer has engulfed his intestines, bones, liver, and lungs. He was in hospice care, getting pain medication every hour, being made comfortable in his last days, when his wife thought he should be taken out of hospice because “all they were doing was giving him pain meds.” As he struggles to breath and the nurse hangs IV Fentanyl, I move on to the next room.

Room two is a patient that we can actually save. It seems rare these days.

Room three is a 58-year old paraplegic who had a seizure and fell unconscious in the back of the medical van transporting him to a doctor’s appointment. He has been in our ICU for 15 days now. He will get a tracheostomy tomorrow as we have been unsuccessful in weaning him from the ventilator.

Room four is another cancer patient. She is 59-years old and was diagnosed with non-hodgkins lymphoma. Through treatment, her immune system was wiped out leaving her susceptible to infection. She has pneumocystis carinii pneumonia, also known as PCP, a yeast-like infection that many Americans know of from its association with HIV. Unable to breath effectively on her own, she is mechanically ventilated and although attempts have been made to get her off the ventilator, her breathing is not sufficient. We will continue to treat her infection, in hopes that her lungs will recover and we can get her off the ventilator.

Room Six came in with aspiration pneumonia from a care facility almost a week ago. He has a chronic tracheostomy; however, he was doing well without a ventilator up to the time that he aspirated. He was in the ICU for several days and moved out to the floor on a trach-mask. Despite nurses instructing the family that he could not eat or drink, family gave him fluids anyway, causing the patient to aspirate again. He respiratory arrested on the floor and was brought back to the ICU. That was 24 hours ago; the patient has not woken up.

Room seven is a severely obese 46-year-old woman who tried to seek a healthier life through bariatric surgery. She now lies in her hospital bed, from which she will never be able to get up. A pulmonary embolism started her downhill spiral from which she has lost her opportunity to die. Her thighs are so big they look like balloons attached to the upper aspect of her legs. The outer layer of her skin on her thighs have blistered and peeled off exposing a layer of pinkish, red flesh. The rest of her skin is also blistered, peeling, and seeping yellow serous fluid. Small clots showered to her extremities have left her fingers and toes without blood flow. Her fingers have turned black and are shriveling down to the bone more and more each day. Her feet from her ankles down are black and her toes are shriveling up too. The nurse applies cream to them several times a day and prays that a finger or toe doesn’t fall off in his or her hand. As the surgeon contemplates the possibility of amputations and prosthetics, the patient wants to die, but it is too late, we already saved her.

Room eight is an 87-year-old man who aspirated on liquid after having knee surgery. His lungs, already severely compromised from end stage COPD, could not recover from this. Now after 30 days in the ICU, having been reintubated four times, getting a tracheostomy for ventilation and a PEG tube for feeding, we can look at placing him in a long-term care facility.

As I walk into room ten, she looks at me and says, “MERRY CHRISTMAS!!” It is the middle of July but I am relieved to see a patient that can talk. I go to check on room eleven.

Eleven has end stage liver and kidney disease and is so yellow that it looks like a three-year-old colored him with yellow magic marker. His power of attorney wants everything done. So there he lies with multiple medicated drips to sustain his blood pressure and circulatory system, a ventilator to sustain his breathing and respiratory system, and a continuous dialysis machine to sustain his kidneys and renal function. He has died and been resuscitated back to life three times now. How many times is too many?

As I walk into room twelve, the man’s weary head lies limber, yielding only to the pillow propped beneath him. His gaze facing the window is distant and looks right through me as if he has already found his world at the end of his rainbow. Fentanyl and Morphine keep him free of pain as his agonal respirations gulp the air. His wishes to die only granted after 25 days in the ICU and a court battle between his power of attorneys. I hold his hand for a moment and then move on to the next room.

Room fourteen was a hernia repair that became infected requiring a thoracotomy to evacuate puss out of her thoracic and abdominal cavities. Post-operatively she developed a perforated esophagus. She is now dependent on the ventilator for respiratory support. Six JP drains still drain purulent drainage.

Room seventeen is another sad case of metastatic pancreatic cancer. It seems to be the cancer of choice these days. The pancreatic cancer grew and spread, tortuous and devious in it’s travels to his stomach and liver, winding up his mediastinum, twisting complexly through the hilum and into his lungs and around his esophagus making its way intricately into his brain. It is difficult for him to breath through his narrowed airway. His daughter who visits him an hour a day wants him to have chemo. I’m not sure what will kill him first, the cancer or the treatment.

Probably the most difficult situation for all of the nurses is room 18. A mother sits at the bedside watching her daughter die a slow torturous death. The patient is 52 years old and suffers from metastatic ovarian cancer. A tumor sits in her heart, inoperable and untreatable. Her children want to sit with her but her boyfriend has Power of Attorney and has limited them. We secretly let them in at night. Fights between him and the children ensue daily. Her body is worn and tired, her muscles atrophied, her skin ashen and gray, her nose, withered and black, has turned necrotic and the necrosis spread across her cheeks like a raccoon mask. Her family longs to make her comfortable, her boyfriend claims she wants everything done.

This is just one day of rounds in the ICU where you will find lives that we save every day. It is apparent that most Americans are not ready for death and rather than embracing it they try to hold on to the very last moment. It is difficult for them to see the suffering that loved ones are going through because they are blinded by their own suffering and loss. Some days it is hard to watch and care for these patients when you feel like you are in a living morgue and knowing that all of your efforts are futile. It is important though, that when we encounter these moments we take a step back and realize that life is bigger than you and as R.E.M. sings, “you are not me.” It is not up to you or me or Barack Obama to judge or say when it is a good time for someone to let a loved one go, but as Barack Obama wants change in healthcare, so do I. I hope that one day the culture of Americans will change and rather than fighting inevitable death, we embrace it and celebrate life. Not the life in our living morgue that lives as harbored souls longing to move on but true, quality life.