I see this all the time and it's nightmarish. Our society doesn't want to accept death, period. Perhaps some of our favorite hospital dramas aught to feature elderly and demented patients in the acute care setting. Zoom the camera in on them and listen to their terrorized screams. Watch as the family who so desparately wishes their loved one to be made better by the miracles of modern medicine hound the staff to do something. Fix it! Or worse, watch as they leave, after all the consents are signed, because they can't bear to see it any longer. Now let's move grandpa into the ICU and put his frail, wasted body on vasopressors to fix his septic blood bressure but first, we need to insert a central line. Watch as he freaks out and thrashes at the sterile drapes that is if he has the strength to do it. Mostly he'll moan and squirm. We can't sedate him yet because his blood pressure is too low, so he has to suffer while the nursing team restrains him. If he's lucky, he hasn't gotten a pneumothorax because of all the movement. Now the line is in so, we can put him on levophed, vasopressin and probably phenylephrine. No Aline because his extremities are too clamped off. Watch as his pale extremities continue to get mottled and cold as the drugs work their magic. Now we can sedate him because he has a blood pressure but only a little, because we don't want to supress his breathing. Oh look, he's having ectopy now. He's in Vtach, get the code cart! Does he have a pulse? A BP? Yeah but it's nosediving. Shock him and watch him lurch. VFib now. Shock him again but turn up the Joules. Still VF. Start CPR. Damn, I just broke his fragile sternum with my compressions but, I have to keep going. First round of code drugs are in and we check for a pulse. It's there but very weak. Grandpa isn't breathing anymore so it's time to intubate him and put him on a ventilator. His PH is now too low for another round of code drugs to be effective should he arrest again, so we give bicarb. He's still having a lot of ectopy so it's likely he'll code again shortly. Where's the family? Oh, they went out for dinner and said they will be back later. Grandpa is alone. What would House do now? There is no exotic diagnosis to be made and treated here. This is called the debility of advanced age and it is terminal. The alarm sounds. Grandpa is in VF again- magically 5 minutes after the first round of code meds have been given. No pulse. No pressure. Shock him again- max setting. VF still. Start compressions again, break more ribs. Push more drugs. Stop compressions. Look, there's some sort of ventricular rhythm. No pulse. PEA. Continue CPR. Look at his neck veins! Quick! Get the sonosite and see what's going on in his chest. Grandpa is on warfarin and now with compressions and all the fractures, I'm thinking he has pericardial tampenade. There it is. Hurry! Get a spinal needle and 60 cc syringe and stick it into grandpa's chest at the apex of his heart and aspirate out all that blood. Okay, done. Is there a pulse? Actually, there is. He pulled through again. Is the family back yet? No. Grandpa is alive but very critical. Amiodrone bolus is running. Let's examine our patient now. Get a flashlight and check his pupils. Fixed. No surprise. A short while later, he codes again while the family is in the room. They're shocked by how sick he is. What do you mean he's gone? He was sitting on the porch yesterday at the nursing home. WHAT? He isn't responding anymore? DO SOMETHING! The code is called after 10 minutes, because grandpa's neck veins were distended again. Probably a ruptured ventricle. The family is asking why that happened. Somebody HAD to be too rough. No grandpa didn't have the ability to come back a third time. Stunned, they sit. You gather the information. The family cries in the room for awhile, then leaves. You take off all the wires, remove all the tubes and do post-mortum care on that poor ravaged body. It takes a while for all the bleeding to stop. Finally you send him to the morgue and call the funeral home. There is still 4 hours left of your shift but you are tired.
I wonder if Grandpa likely would've preferred to die with dignity in his own familiar bed with family holding his hand. We will never know because nobody asked him.