The subject seemed at odds with the sunny summer’s day. The cicadas and the midafternoon traffic were so loud, it was hard to hear. No one wanted to say the word “death” aloud. Ms. MacLean touched Mr. Eybel’s arm and said, “I know you know.”
He couldn’t speak, but he mouthed the words, “I have to put things in order.” He refused to authorize the DNR, and stayed “full code,” meaning he wanted everything medically possible to keep him alive while he pondered his future.
It may have been a question of too much too soon. “You are trying to accept your mortality,” Mr. Bisley said, “and it’s scary as hell.”
They returned to his room. Mr. Bisley had already obtained a doctor’s permission to give Mr. Eybel something he keenly wanted but thought impossible in a hospital – a cold beer. The nurse syringed liquid from a chilled can of Canadian, then pushed it through Mr. Eybel’s nasogastric tube.
Mr. Eybel was able to pick and choose which treatments he wanted – pain relief, a comforting beer – and which he would forgo, such as radiation. Others seek last-ditch medical efforts of little value, believing they may be the long shot that pays off. Even Mr. Eybel was seeking a second opinion.
No one can be sure how long they will live, not even doctors, and it is hard to give up hope.
Searching for a voice, through the respirator’s forced silence Each day, the physicians here go on medical rounds, discussing patients’ conditions in a shorthand of numbers, letters and vital signs.
Families can stay and listen, and sometimes witness life-saving acts of cardiopulmonary resuscitation. In person, this place can be more intense than any TV medical drama.
An electronic pass, a long corridor and three sets of stainless-steel doors take you inside, where doctors and nurses cut arteries and vessels in patients’ necks, heads, groins and arms and transform them into highways for monitoring and medication.
These patients are so ill, some of them so lacking in response that, unless a doctor shows you, it can be hard to tell if they are alive or dead.
A catheter in the groin helps the heart pump blood; a tube down the nose into the stomach provides nutrition. A tube monitors blood flow and another tracks swelling in the brain.
One machine universal to all is the mechanical ventilator, a breathing apparatus that distinguishes critical-care patients from all others.
Its use today might seem indiscriminate to the Danish inventors who created the first manual version in 1947-48, as the polio epidemic ravaged Europe and the United States.
Today, it can keep alive patients for months, even years, who would otherwise die without it.
A ventilator means living either in an institution or under 24-hour supervision. One patient at Sunnybrook remained in critical care for 1,176 days (more than three years) before death – the average stay in a Canadian intensive-care unit is just over four days.
Some patients are placed in open areas for easy access to the nurses’ station, while others are moved to the more spacious rooms with windows at the far end of a corridor.
Bonnie Isacovics, a patient with multiple sclerosis, was placed near the entrance. A loss of consciousness and fever had forced Ms. Isacovics, 54, into the hospital in late May. She came to the critical-care unit in July to be treated for pneumonia.
Before that, she had been living at home in North York, Ont., with her teenaged daughter, Beatrice, and her husband, Morty Goldmacher, along with two paid caregivers and her dog, Denis, who would sit at the foot of her wheelchair.
Long ago, in 2002, she’d had to leave behind a job she loved dearly and held for 15 years, running a rheumatology research laboratory at the Hospital for Sick Children.
But Ms. Isacovics had soldiered on with MS for 14 years, adjusting to a disease that had attacked every part of her body but left her intelligence intact.
Though locked into a body that no longer worked, she could still make treatment decisions. She could not speak on the ventilator, and MS had made her hands unable to write, but she could nod, mouth words or spell things out by pointing to the black alphabet letters on a white, plasticized board that was provided to her.