Mcnamara seeing joes hearing aid gleam under the room

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McNamara, seeing Joe’s hearing aid gleam under the room light. “Joe,” Dr. McNamara said loudly. “Joe, you have no control over your esophagus. When you swallow, food and water are going into your lungs, which is making you sick. You have developed pneumonia from the infection. We can treat the pneumonia, but we need to put you on a ventilator (which is a breathing machine) and a feeding tube (to directly deliver liquid food into the stomach). We’d sedate you so that it wasn’t uncomfortable.” Joe stared up at Dr. McNamara, blinking several times. His right eye drifted off to look into the corner of the room, but his other eye was focused on Dr. McNamara. “Do I get an operation?” Joe asked. “OK, but I don’t want tubes, and please don’t cut off my big toe.” Dr. McNamara sighed. Joe was running a fever and his oxygen levels were low in his blood. It was hard to talk to Joe in the best of times, so Dr. McNamara wasn’t completely sure that Joe had understood him now.
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He tried again, shouting more loudly. “Joe! You have pneumonia. We need to treat it. You are very sick. We need to put in a ventilator and a feeding tube. Once the pneumonia is cured, we may be able to remove the tubes.” Joe shook his head, eyes rolling. “Go away! No tubes! No tubes!” Dr. McNamara looked at Joe’s file. Seven years ago, Joe had checked himself into the local nursing home. When he entered the nursing home, and again three years ago, a patient advocate had helped him fill out an Advance Directive which stated Joe’s medical wishes. Joe had clearly indicated that he did not want a ventilator, a feeding tube, or drastic cardiopulmonary measures such as CPR. Dr. McNamara wanted to put Joe on a ventilator, but it was fairly clear Joe didn’t want one. However, without the feeding tube and ventilator Joe would certainly die, probably in a week or two. Dr. McNamara checked again. Joe had also filled out a Durable Power of Attorney, in which he stated he wanted his younger brother Ernie to make medical decisions for him in the event he was no longer able to do so for himself. Dr. McNamara got up and left the room. He was convinced that it was time to call Ernie. It wasn’t clear to Dr. McNamara that Joe really understood what was happening to him, and Dr. McNamara had always felt that it was courteous to involve the entire family when possible. Dr. McNamara called Ernie and explained the entire situation. Ernie is a rather shy, 63-year-old man. Living quietly at home, Ernie has Crohn’s Disease and some arterial damage, including fairly major blockages in the arteries feeding his kidneys. Ernie has never married, and he doesn’t like to make decisions. Ernie sat down, still holding the telephone, and sighed. Poor Joe! What should he do?
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