Although we are not participating in the care of comedy legend Joan Rivers, we have noted news reports that her daughter Melissa has said her mother is out of the ICU and being kept comfortable.
Rivers was hospitalized six days ago after suffering cardiac arrest and a prolonged anoxic period (brain without oxygen.) She was placed in a hypothermic coma (lowered body temperature) as is standard for the first 24-48 hours after arrest in an attempt to salvage brain and cardiac function.
However, reading between the lines of this recent statement, this is likely an ominous development and could signal the start of a comfort care protocol using intravenous drips of narcotics such as morphine and benzodiazepines such as Ativan.
It is very typical when patients who do not regain consciousness after cardiac arrest and hypothermia to have the breathing tube removed and to be started on a high dose of continuous medications to keep them from feeling distress or struggling to breathe.
Morphine is both an analgesic (painkiller) and has sedative effects. Ativan is also heavily sedating. The desired outcome is to prevent patients who are dying from feeling any distress. It is generally acceptable to use drugs that are sedating enough to hasten death if the intent is to prevent distress.
Once a patient who has experienced severe anoxic brain injury family decides to withdraw care, it is very typical for the patients to be moved out of the ICU for more comfort and privacy for the family. ICUs are noisy, brightly lit hospital wards with constant “hustle and bustle.”
If Ms. Rivers was recovering brain function it would be more typical for a statement saying something like “she is responsive and the doctors are hoping for a full recovery.”
In the absence of that, it will likely be bad news soon.
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