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You may notice that my posts about the ICU often carry a theme of how to approach the end of life. We see so many patients here who face that question and have given it very little thought. When the circumstance is sprung upon them, they are adrift. Consequently, as I wade through their troubled ICU course, I ruminate on it, and meandering thoughts find their way here. The other day, we had a patient who was a hundred years old come in with septic shock as a full code. He wanted everything done for him if necessary - chest compressions, mechanical ventilation, long term artificial nutrition, shocks. Of course, that is his right. But it got me thinking about age. I'd like to think I don't discriminate on age, that I don't look at a hundred year old patient any differently than a third year old. But the truth is that elderly patients are frail, they have little reserve, and they cannot weather the strain of the ICU as well as they could years ago. That colors the way I look at code decisions. The survival odds are clear; a young person is much more likely to make it if their heart stops than a little old lady. But words like this run afoul of being condemned a "death panel." I'm not out to kill any grandmothers. But I feel that it is a disillusion and disservice to pretend that an octogenarian has a good chance surviving cardiac arrest. I'm struggling with this right now, and maybe I'm wrong, but at least I'm thinking about the issue.