Heroic measures after DNR stirs the debate

HOUSTON, Jan. 5 -- The rules are different for demigods.

On
the final day of 2005, pioneering heart surgeon Michael E. DeBakey,
M.D., was alone at home preparing a lecture when he experienced sudden,
piercing chest pain that migrated to his neck, symptoms he soon came to
recognize as those of a dissecting aortic aneurysm.

Dr.
DeBakey was 97-years-old and had decided that he didn't want to endure
the surgery necessary to repair the defect. With an irony worthy of
Greek tragedy, Dr. DeBakey himself had helped to develop the procedure
and vascular graft in 1953, using a Dacron sheath he devised at home on
his wife's sewing machine.

Yet Dr. DeBakey eventually underwent the grueling seven-hour procedure. "If they hadn't done it, I'd be dead," he said.

The
surgery, performed in early February 2006, bought Dr. DeBakey at least
one more year, but at the cost of a long, painful, and difficult
recovery marked by kidney failure and dialysis, a tracheostomy, six
weeks of mechanical ventilation, parenteral feedings, and the
possibility -- although not the eventuality -- of brain damage.

The
bill -- no one is quite sure of the amount, and Methodist Hospital here
won't comment -- is estimated to be well more than $1 million.

Few
would argue that the world is richer for the presence of Dr. DeBakey, a
man who comes as close as any to the status of a deity in the pantheon
of modern medicine and surgery.

But the facts of his case, which he and his physicians agreed to share with the public via a detailed article in the New York Times by Lawrence K. Altman, M.D., raise questions about end-of-life care, patient rights, and the use of limited medical resources.

For example, although he had a "do not resuscitate" order (which he
later could not recall having made) and a note in his chart stating
that he did not want surgery, and although anesthesiologists at the
Methodist Hospital refused initially to put him under because of those
directives, the demands of his family and the judgment of his
physicians overrode Dr. DeBakey's wishes.

Then there are the questions about the patient's age