Case 39-2011 — A Woman in Her 90s with Unilateral Ptosis

Until I read this article in the Dec. 22, 2011 New England Journal of Medicine I didn't know what ptosis was--it means drooping eyelid. What interested me about this story was that the patient who woke up one morning with a drooping eyelid was in her 90s. She was living independently, and walking 50-60 minutes a day, but she also had high blood pressure, high cholesterol, osteoporosis, and a number of ailments known to the elderly plus a pace maker put in 5 years earlier. She was taking a long list of medications plus vitamins. Then she was started down a long road of tests, more medications, hospitalizations and rehabilitations for 8 weeks. Several CT scans, fluid restriction, lab tests, physical tests, ECG, chest radiographs, special diets (she was having difficulty swallowing), supplemental oxygen, a neck collar (for muscle weakness), intravenous administration of 5 drugs and 2 more with a nebulizer. Mercifully, after eight weeks of being a lab animal, she and her family decided for comfort measures only, and she died in 3 days.

After ruling out various things with the CT the doctors had pretty much settled on myasthenia gravis with a thymoma (tumor) which was confirmed in the autopsy. I read a few articles on the internet and thought her symptoms (even with no tests) sounded like MG. There's even a blood test for it, but I didn't see where she had that one--but maybe I missed it in the long list of other tests. There is no indication in the article if all this was done because she insisted, or whether doctors just keep going until they run out of options.

Surely, there must have been a better way for her to spend the last eight weeks of her life. I don't think we want death panels set up by the government deciding our fate, but would it have been unethical for someone to have had a talk with her about how she wanted to live her final days?