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Harriet Maclean at her partner's bedside in the ICU ward at Sunnybrook Hospital. Rheo Eybel was diagnosed with Glioblastoma, an aggressive form of brain tumour. (Moe Doiron/(Moe Doiron/The Globe and Mail))

Harriet Maclean at her partner's bedside in the ICU ward at Sunnybrook Hospital. Rheo Eybel was diagnosed with Glioblastoma, an aggressive form of brain tumour.

(Moe Doiron/(Moe Doiron/The Globe and Mail))

Critical care: Spending 10 weeks with patients facing death Add to ...

That was the day, it seems, that Ms. Isacovics decided that if she could ever get out of here, she wanted to live after all. A well-laid plan and a leap of faith Betty Pritchard made her choices for the end of life long before they were needed. Only three paragraphs long, her statement from Aug. 4, 1994, left no doubt about what loved ones should do if she wound up in a place like this, with an injury like hers.

“If at such time the situation should arise in which there is no reasonable expectation of my recovery from extreme physical or mental disability, I direct that I be allowed to die and not be kept alive by medications, artificial means or ‘heroic measures,’ “ said her typed, one-page letter, found in a purse in her Brantford, Ont., apartment.

“I do, however, ask that medication be mercifully administered to me to alleviate suffering, even though this may shorten my remaining life.”

On July 18, it was Ms. Pritchard’s third day at Sunnybrook. A heat alert had just been lifted, but the weather outside the window remained impossibly warm, at odds with the raw suffering of the patients inside. Hospital chaplain Klara Siber, a calm voice for many under duress, walked over to bed 40 and introduced herself. She had been sent by Ms. Pritchard’s son to pray with her.

“I didn’t get a sense of her response until I said the Lord’s Prayer,” Ms. Siber said. “I could see her nodding and trying to mouth the words.”

Ms. Pritchard was a religious woman with a religious son – a minister. She had told him she had known from the time he was in the womb that he was destined to be a man of the cloth.

She was a social woman too – a grandmother who stayed in touch with friends on Facebook, was on the executive of her seniors group, was active in her church and was excited to have passed her driver’s-licence renewal at the age of 86.

What had brought her here was a sideways fall down a flight of stairs at a relative’s home in Toronto, caused by a drop left foot due to the polio she had developed when she was a small child. Her fractured neck left her quadriplegic and on a ventilator, with an uncertain future.

That Monday morning, Dr. Fowler was about to begin leading medical rounds with a roving posse of specialists, specialists-in-training and medical students. Of the three paths to becoming a critical-care physician – two years of training on top of a specialty usually in surgery, anesthesia or internal medicine – he had taken the latter, ending up here at Sunnybrook, a long way from his primary-school years in a two-room schoolhouse in rural New Brunswick.

He stopped at Ms. Pritchard’s bed to hear the nurse describe her condition, then noticed the patient was awake and alert. Even though she was paralyzed and could not speak through the ventilator, she could nod her head and blink her eyes. He touched her arm and leaned into her face, telling her that he knew she could hear him, that he knew the tube was unpleasant and that he would try to make her as comfortable as possible.

Her son, he said, had told him what treatments she did and didn’t want. They would respect her wishes. Would it be okay for her son to advise him on that? She replied with a vigorous affirmative nod.

Around 5 p.m., her son, Rev. David Pritchard, minister of Grace United Church in Niagara-on-the-Lake, Ont., was in the critical-care meeting room, hurriedly flipping through his address book, calling relatives across Canada. He referred to this spot as the “room of tears,” the place where doctors break bad news. This time it was his turn: Life support, Mr. Pritchard told family members, was going to be withdrawn.

“To me, this isn’t a hard decision. If mom said that, then that’s what she wanted,” he said. “To be trapped in a body where she can’t express her feelings, that would be torture for her.”

Ms. Pritchard’s nurse, Lukshmi Perampalamoorthy, sat at a desk at the end of her bed, penning in vital signs on a huge sheet every hour. Before she left for home that evening, she had one more thing to prepare for the evening nurse – to measure out the morphine that, among other drugs, would be used to help ease the patient off life support.

She took her usual 30-minute walk home, thinking about Ms. Pritchard.

“I had personal feelings of anxiety, of not knowing is this the right thing, is this a good thing. There’s always that: What if things could have improved more?” she said, adding that even when a patient’s wishes are fulfilled and there is no disagreement, a death can still feel unsettling.

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