Making Decisions about My Mother’s Treatment Shook the Foundations of My Sense of Wellness

by William R. Blythe, MD •

Two days later, she was short of breath and couldn’t get out of bed, so I arranged to have her admitted to the Internal Medicine Resident Service at my hospital, under the supervision of my longterm friends and colleagues. Her oxygen saturation was in the 80s on admission, which was surprising to us all.

After her admission, she seemed to rally briefly, although she required oxygen continuously. On the second day, she underwent a chest computerized tomography scan, and it was shockingly nasty: There was severe interstitial lung disease and inflammation, the dreaded “ground glass” appearance that we have all come to fear. She tested negative for COVID-19 and every other respiratory pathogen, but I remained skeptical. She was treated aggressively for everything we could think of—diuresis for possible congestive heart failure, steroids for interstitial lung disease, antibiotics for atypical bacterial infection—but she only worsened.

I am certain that everyone gave my mother extra-special care and went out of their way to communicate because of who I am. But they also deferred decisions to me and asked for my approval on treatments, which probably wasn’t the best approach for my mother. —William R. Blythe, MD

I have tremendous confidence and trust in my colleagues. All the subspecialists saw her, including cardiology, pulmonary, infectious disease, and cardiovascular surgery. We have a relatively small medical staff of 230 physicians, and I have been in leadership positions for two decades and am a past chief of staff. I know all her doctors well, and they know me. Having a physician son is a double-edged sword. I am certain that everyone gave my mother extra-special care and went out of their way to communicate because of who I am. But they also deferred decisions to me and asked for my approval on treatments, which probably wasn’t the best approach for my mother.

And that’s where we found ourselves on the morning of July 15. Mama was struggling to breathe and was on 100% oxygen by bilevel positive airway pressure (BIPAP). She was miserable and parched from diuresis. She was breathing 40 times per minute, and she kept begging for something to drink. But to remove her from BIPAP for even a minute for mouth care dropped her oxygen saturation into the 70s, and she was slow to recover. It was human torture, albeit well intended. I could not bear to witness it.