One of the Yup'ik elders on my service has the dwindles. He's 87, he has Lewy body dementia, and he has slowly been losing his strength and mobility over the past several months. He was originally admitted for acute R gluteal pain that radiated down his leg, likely secondary to a herniated disc at L4-L5; but he soon stopped eating and drinking altogether. He has an amazingly large and caring family, all of whom are deeply invested in his well-being. I have had numerous conversations with his siblings, adult children and adult grandchildren about his prognosis all week. We had a family conference by speaker phone yesterday so that family here at the hospital could communicate en masse with family back home in the village. The ones who had been in Bethel all week by his bedside felt strongly that he should go home to familiar surroundings. The ones in the home village were less certain and wanted to try more aggressive interventions (i.e. artificial nutrition by NG tube) in the hospital. The patient's sons were on their way home from fish camp (everyone sets up fish camp by the river in the summertime, in order to catch and then slowly dry an adequate supply of salmon and herring to last throughout the winter).
This morning, it was decided that the patient would go home to be cared for by family. I put in a special request for a "reverse medevac" because he was too weak to sit up for a commercial flight home. An Expected Home Death form was filed in his chart. When the paramedics finally arrived (the flight time had been delayed several times due to regular medevac requests that pre-empted the reverse medevac), we all got a little teary-eyed. The family graciously thanked me, and there were hugs all around.
After the plane took off, I tiptoed to L&D and sat quietly in a rocking chair for a few minutes, holding the baby I had delivered the day before, which somehow made me feel just a little bit better.
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