Food and the dying patient

NEW YORK — The patient had dementia and could no longer swallow. The intricate workings of the muscles of her throat were failing, and she was no longer able to move food or liquids reliably into her stomach. Instead, they too frequently ended up in her lungs, and she drowned a little more with every swallow. She was admitted to my intensive care service with pneumonia from aspirated food that had turned the bottom part of her left lung into a wet sponge. Her blood oxygen levels had dropped so low that we had to support her breathing by inserting a tube.

Now, after she was on powerful antibiotics and life support for three days, her oxygen level had improved and her fevers had abated. She was getting better, in a manner of speaking.

This pneumonia was her third, and easily her worst, in four months. This pattern is typical of end-stage dementia, when patients lose control of their swallowing mechanism and often die from the pneumonias that result from food lodging in the lung. Usually, these patients have gone in and out of the hospital through a sort of revolving door; as soon as one pneumonia is chased away by antibiotics, another emerges.