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PARIS – “Dear Mrs. Denise, you will not read this letter.” Thus begins the extreme tribute that a group of French doctors wanted to pay to a ninety-year-old woman who died of Covid last March after choosing to leave her place in intensive care to a younger person. A letter just published by the newspaper The world which moved to France. When Denise arrives at the emergency room of the Paris Saint-Louis hospital in spring, she is already “out of breath and with all the signs of infection,” the doctors recall. “Neither his almost cured cancer, nor his heart failure, nor his advanced age prevented him from entering intensive care,” adds the medical team. Denise knows there is only one bed left in the ICU. And together with his family, he decides not to be sedated or intubated.
“He wanted to leave that place to his children and grandchildren,” explains Elie Azoulay, the head of the Saint-Louis resuscitation service, who signs the letter together with another doctor from the unit and two department heads from Parisian hospitals. The old woman asked many questions before deciding. He wanted to know if there was enough oxygen and respiration for all the patients, what the physical and psychological consequences would be if they recovered. And in the end he communicated his decision to the hospital, in what in end-of-life jargon is called “informed consent.” The woman’s son later confirmed the mother’s will.
Even if there was no ambiguity on the ethical and legal level, Denise’s choice surprised the medical staff. “For a long time we thought that we had influenced their attitude by answering their questions”, confide the doctors who relate the emotion of nurses who fought to the last in having to respect the extreme choice of the patient. “His decision not to occupy this intensive care bed and leave it to others prevailed – the letter continues – and his perception that the machines would have unreasonably prolonged his suffering.” Probably, doctors add, the moral dilemma shared with patients and their families would also arise in the case of other serious pathologies for which the possibility of surviving intensive care techniques is weighed. But it is also true that this dilemma has become even more painful since the beginning of the epidemic. Many intensive care units have had to start a reflection on the admission criteria even if the French health authorities deny that there has ever been a triage to the detriment of the elderly.
Denise, doctors say, has faced a form of “modesty and dignity” in recent days surrounded by her son and grandchildren. “She never complained, her suffering was silent.” Denise’s resuscitation post was occupied by a man transferred from another region with meningitis. The memory of Denise continues today accompanying the Saint-Louis hospital medical team in the trench against Covid. “We will never forget the serenity and softness of his large black eyes,” conclude Azoulay and the other doctors in the letter. “We will never forget that he asked us to go care for patients who had the opportunity to do so. There were a few days left in his life, but his smile was the same as always ”.
