Conversations with Stella

• Physician's role
• Physician-patient relations
• Knowledge, attitudes, practice
• Ventilators, mechanical
• Advance directives

Stella and I are good friends. She trusts me, I trust her. On the phone today, she tells me about her fever and cough (“emphysema is hell”). I tell her to call the rescue squad. She tells me not to put her on a respirator (“last November was hell”). Stella is smart and capable of making decisions for herself.

I wonder whether she really means “no” this time. One question or statement in a conversation can make all the difference. On the way to the emergency room, I imagine several different conversations.

Dr. G.: “Stella, you told me on the phone not to put you on a respirator.”

Stella: “That's right.”

Dr. G.: “Under no circumstances?”

Stella: “Under no circumstances.”

Dr. G.: “I understand. I will respect your wishes.”

Stella: “Thank you. I knew you would. You have relieved my concerns about dying helplessly …