Eine Kleine Nachtmusik: This Business of Withholding Cortisone

Many people don't know that Addison's Disease results when a person's body stops producing its own supply of Cortisone. For a patient with Addison's Disease, continuous administration of Cortisone is totally and absolutely necessary to sustain life, in the same way that breathing oxygen is absolutely necessary to sustain life.

Perhaps there are always questions, with any elderly person's death.  But ... my opinion is that for any patient with Addison's Disease, and certainly for a debilitated, elderly woman with Addison's Disease who has just survived pneumonia with body temperatures of up to 105 degrees, the withdrawal (or non-administration) of Cortisone probably caused CERTAIN DEATH. It ensured that death would come SOON.

In Susan's case, my opinion is that the withdrawal (or non-administration) of Cortisone caused my mother to experience a three-day death agony whose extraordinary and unendurable pain was poorly controlled by morphine, and during which time of suffering any possible verbal protest from Susan was stifled by whacking big doses of Haldol, a potent anti-psychotic drug that makes talking or even thought more or less impossible. I have photographs that indicate Susan's death was very painful and agonizing.

My opinion is that withdrawing Cortisone from or not administering Cortisone to Susan resulted from a two part order by her attending physician, Dr. Rissman -- of Woodstock, New York.  First, Dr. Rissman's order "nothing by mouth" mysteriously included not only food (which Susan might have choked on) but also Susan's usual and customary oral Cortisone tablets, and Second, no intravenous administration of Cortisone was ordered to replace the oral tablets.  Meanwhile, however, as far as I know, Susan continued to receive intravenous fluids, oxygen and intravenous antibiotics.  She continued to receive antibiotic therapy to combat pneumonia and MRSA, an iatrogenic infection she developed while dying in Benedictine Hospital.

On the morning that Susan's life-enabling and life-sustaining daily dosage of Cortisone was stopped -- this was the Cortisone on which Susan's life had absolutely depended for at least the previous ten years! --  Susan had actually managed to fight off the pneumonia, and her body temperature had returned to approximately normal. My opinion is that after her high fever abated, Susan was as coherent on that morning and on that afternoon as she had been at any time during the last three or four years.

My opinion is that withholding or withdrawing the administration of Cortisone caused Susan's Death, just as it would have caused the death of any patient with Addison's Disease (one of the "five fatal diseases" Susan was suffering from at the time of her death).  To be quite clear, my opinion is that withholding or withdrawing Cortisone was the proximate cause, and perhaps even the main cause, of Susan's death.  My opinion is that there is no telling how much longer she might have held on to life.

True, she might have died soon anyway.  But witholding or withdrawing Cortisone made Susan's Death not only certain but also unnecessarily painful.

My brother Rob Gehman was the first to notice that Susan's Cortisone was no longer being administered intravenously.  Rob was so shocked and surprised that, thinking there must be some mistake, Rob went out into the hall to call Lowell Bair at home.

Meanwhile, I went out to the nursing station to ask some questions.  There, on the morning after the night on which  Susan's customary dose of life-sustaining Cortisone was first withdrawn or not administered, my opinion is that I overheard one of Susan's nurses at Benedictine Hospital ask her Nursing Supervisor point blank "Could I be cited for malpractice as a result of withholding Cortisone from an Addison's Disease patient?"  Significantly, the supervisor replied: "No, you'll be in the clear because you were only following Dr. Rissman's orders."

Strange enough, but I did not particularly remark on it at the time, except to note it down in my journal.

I believe that nurses and doctors may often make similar decisions to end the life of an elderly patient if the family agrees by withdrawing the customary and necessary dosage of a drug or drugs that have been necessary to sustain life.

But perhaps what makes it even stranger is that almost a month before I overheard this rather startling (to me, anyway) colloquy between Nurse and Supervisor, during Susan's first stay on the critical care ward at Benedictine, while sitting in the critical care ward's family lounge, I listened with amazement while -- this is my best recollection -- this same Dr. Rissman told the entire extended family of a middle-aged diabetic from somewhere up past "Onteora" that the poor soul, despite being hooked up to the full gamut of the critical care ward's usual superb modern monitoring equipment,  had somehow  "gone twenty minutes without a heartbeat" before anyone noticed that there might be something amiss. And as a consequence the pour soul was brain dead and could not be expected to survive the afternoon.

Because the critical care ward's modern monitoring equipment tracks (as far as I know) heart rate, pulse Ox, respiration, blood pressure and perhaps other vital signs that I know nothing about and as far as I know sounds an audible alarm when a life-threatening situation SUCH AS NO HEARTBEAT develops, it is fair to wonder: what could possibly have happened to that poor soul?

My opinion is that it does seem almost unbelievably strange (does it not?) that no nurse, doctor or supervisor noticed -- until too late -- that the patient's heart had stopped! For twenty minutes!   With no response from Benedictine's wonderfully professional critical care nursing staff!

My opinion is that it may be fair to wonder: Was there perhaps a doctor in that poor soul's room? Which might have prevented the nursing staff from making further inquiry?

How could this have happened, Doctor?

But I suppose -- in my opinion it is natural to think -- that these two cases might more likely be the rule than the exception -- with some doctors.  Anyone who doubts that this could even possibly ever happen at Benedictine Hospital in Kingston, New York, might do well to read Sybille Bedford's interesting book The Best We Can Do: (The Trial of Dr Adams), published in 1958.

Dr. Rissman was Susan's doctor for, as far as I know, for more than ten years.  In my opinion, it is reasonable to assume that Dr. Rissman actually did know that withdrawing or withholding Cortisone would probably, perhaps almost certainly cause Susan's Death in short order.

I also noticed that the attitude of the nurse attending Susan on the night before she died changed; she had been friendly and retreated into a distant professional attitude that I found a bit strange until Rob noticed that the administration of Cortisone had been withdrawn.  My opinion is that I remember that on the night before the administration of my mother's Cortisone was withdrawn, her daughter Connie Bair, after visiting Susan at her bedside, said as she left the hospital: "It's time for this to end" or "It's time for this to be over."

You may not like to believe, as I do, my opinion that it would have been much kinder and more merciful -- and also, in my opinion, much quicker and less painful -- to smother Susan to death with a pillow.  Though that would have been over in five minutes, of course that would have been considered "killing."  Or to use the precisely right term, murder.

But ... such "mercy killings" happen all the time.

My opinion is that Susan's husband, Lowell Bair, must have made this decision, probably in consultation with my half-sister Connie Bair.

You may not agree with my opinion, that withholding Cortisone from or not administering Cortisone to an elderly woman with Addison's Disease is tantamount to killing her outright.

My opinion is that perhaps this was not murder -- perhaps it was just "mercy killing." Probably my mother Susan Bair would have died before long anyway.  But who's to say?  In fact she died shortly after the intravenous administration of Cortisone was stopped.

My further opinion is that:

Anyone who has a similar story regarding the death of a loved one, or who has questions about any doctor similar to those I still have about Dr. Rissman and his role in my mother's death would be very welcome to contact me.

Now it seems that noticing the above and sending copies of it by email to my sister and my brother have caused Lowell Bair to disinherit me; under the terms of the Will that Susan signed I would receive one fifth of the joint estate. But I believe my siblings Rob Gehman and Connie Bair Thompson and Lowell are looting the estate. Which in my opinion would make them all "murdering thieves."