At 2:00 am one morning, when I was a much n younger attending physician, I received a call from na resident on service in the ICU. He called about a ncase with “an FYI,” because he had a few minutes nand thought I might want to be informed. He told me nof a 25-year-old man admitted that night with what nappeared to be severe community-acquired pneumo-nnia. The patient carried the diagnosis of developmen-ntal delay, but, the resident informed me, the patient nhad been previously determined to be legally compe-ntent to make his own decisions by the courts, and he nlived alone. The patient was developing acute respi-nratory failure, and he refused intubation and mechan-nical ventilation. The resident informed the patient nthat he would likely die without this treatment, and nthe patient told the resident that he understood. The nresident tried noninvasive ventilation, and the patient nrefused it. The resident was calling to tell me that nhe was planning to transition to comfort measures nonly. The team had tried unsuccessfully to reach nthe patient’s parents, although the social worker was nstill trying.
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