Case Study: Harriet Billings, a 76-year-old retired nurse developed endocarditis and mitral valve dys-function from an infected pacemaker lead, Harriets past history included a 3 month hospital stay following mitral valve surgery 7 years earlier. she was overweight and had longstanding chronic lung disease but was precise in managing all her medications. Harriet had lived alone for the past 1 year following the death of her husband. She had recently updated her advance directive and Durable Power Attorney for Health Care, reaffirming that she wanted to be intubated, have hemodialysis and to have cardiopulmonary resuscitation, should they be necessary. In addition she gave her brother power make healthcare decisions for her should she become incapacitated.
Harriet was awake and able to understand what was occurring to her when the cardiac surgeon at her local hospital explained that her chances of surviving a second operation on the valve.