Feel Good, Inc.

Dr Pasteur tells me the emphysema lady has failed several attempts to wean her from life support. She’s been lucid enough to refuse a tracheostomy, a surgery required for long-term mechanical ventilation, and has asked to be removed from the machine, understanding that this will likely result in her death.

Intubated patients typically have their wrists tied to the bed and require huge amounts of sedation to tolerate the tube that goes 23 centimeters down their throat and the machine forcing air in-and-out of their lungs. Here’s an interesting thing about the long-term effects of smoking: emphysema patients often find the experience of being intubated refreshing compared to their typical sensation of suffocation. Because of this, they don’t require much sedation and are able to communicate and interact while intubated.

When I swing by her room, her family is at her bedside. The nurse tells me they’re waiting for the arrival of one more family member before removing the tube. I go in and talk to the woman for a moment. She recognizes me and writes the words ‘how long’ on a legal pad.

‘Before they take the tube out?’ I ask.

‘No,’ she writes, ‘after.’

She’s asking me how long she’ll have until she dies. She has more foresight than many people. Most people wait until after the tube is out to ask this, imaging it will occur right away.

‘I can’t say ma’am. It might be hours. It could be months. Physicians are notoriously bad for those kinds of estimates,’ I tell her. Then I lean in and—in sotto voce—say, ‘We’re not really God, we just think we are.’

The ventilator alarms go off when she bucks it, laughing. Her family laughs too. Even lame jokes go off like gangbusters in a room like this, everyone aching for a moment of life as they await death.

After a moment she writes, ‘how long really?’

She stares at me for a moment then underlines the word ‘really.’ I look at her husband and then her. They both stare at me expectantly. I pick up the vent sheet to check her blood gas and the vent settings. I give a little shrug, then say, slowly, ‘between six and twelve hours, probably.’

Everyone closes their eyes.

She writes ‘thank you’ on her legal pad.

Her husband shakes my hand.


Two hours later, I receive word that she died while her family was in the cafeteria, thinking they had more time.

Fuck, I think. God fucking damn it.