Time is flying by and the number of difficult tube feeding cases I am seeing continues to grow. Since August 2010 my stomach has been in knots over Mr. C, an 88 year old patient with end-stage dementia. He was not eating and his family doctor recommended placing a PEG tube. A surgeon agreed to do the minor surgery even though the patient was severely demented and in poor physical condition. The family doctor insisted that the man should not recieve food via the PEG, only fluids and medications. To me this seemed like the ultimate poor medical decision; his intake was so poor that he would surely pass away in a few weeks from starvation. When I spoke with the family and asked them to consider feeding through the tube, his wife said "I'll do whatever the doctor wants"-which meant no food via the PEG tube, much to my dismay. So he continued to recieve a pureed diet for three meals daily, even though he was not eating.

Fast forward 6 months. Since the PEG tube was placed in August, his meal intake has been very poor for months. He has recieved enough fluid through the tube to keep him alive but receives virtually no protein, carbohydrate, fat, vitamins, or minerals. Mr. C has essentially been starving to death. Now, in addition to his mental debility (Alzheimer's Dementia) has has even more severe physical debility because of his poor nutritional status. He lost over 75 pounds. Every time I check on this resident, I am amazed that he has not passed away.

However, on a recent visit to the patient I was amazed to learn that he has begun eating again, often 50-100% of his meal trays. He remains very demented and can do almost nothing for himself. If he continues to eat, he could live on for years to come, although he will remain very debiliated and confused. To me, this case is a shocking illustration of "life at all costs". Yes, Mr. C is still alive, but he cannot speak, feed himself, walk, or recognize his wife and children. Has being given fluid only, no food, through his PEG tube saved the patient's life? Or has it caused him to die a slow, agonizing death and prolong the inevitable?