That was the situation for 46-year-old Sam Varghese, a Sugar Land dentist, who choked while eating a steak dinner with his parents and adult son in Austin on May 9, a lawyer said. Varghese’s brain was deprived of oxygen, and he was left in a coma at University Medical Center Brackenridge.
Doctors determined his condition was terminal and irreversible. They said ongoing care would be futile and recommended removing him from a ventilator Friday evening — when a court’s restraining order was to expire — with the agreement of Sam’s wife and their 19-year-old son.
Sam’s case reflects the wrenching and sometimes public battles that can occur when family members disagree about whether to stop providing life support or other care near life’s end. It also points to problems overwrought families face when a loved one has left no living will, called an Advance Directive in Texas. Sam’s pending divorce adds yet another layer of complication.
Sam’s brother, Sajan, sought to be named guardian and fiercely resisted withdrawing care.
“We need time to nurse him back to life,” Sajan said Friday afternoon. He lives in New York and said he is a medical doctor but is engaged in research, not clinical practice.
Sajan asked Travis County Probate Judge Guy Herman to stop Sam’s wife of more than 20 years, Aji Thankachan Varghese, from becoming his brother’s guardian. Sajan argued in a court affidavit that Aji had “an inherent conflict of interest” because of a “contentious divorce proceeding.”
“Aji appears to want life sustaining care withdrawn as soon as possible and at all costs,” Sajan wrote in the affidavit. “She has also mentioned that as a nurse, she doesn’t make much money and that she is a beneficiary of my brother’s life insurance policy.”
Herman named Sam’s son, Jonathan, a University of Texas student, as guardian. Sam also has a 17-year-old daughter with his wife.
Aji’s lawyer strenuously disputed that his client had any desire to quicken Sam’s death or go after his money.
“Aji, I truly believe, was doing her absolute best, divorce or not,” said Gregory Godkin, her Austin lawyer. She’s a registered nurse at UT’s MD Anderson Cancer Center and has been at her husband’s side since he went from dining at the Four Seasons to the hospital two weeks ago, he said.
Godkin, whom Aji allowed to speak on her behalf, said Sajan presented no evidence to prove she was motivated to quicken her husband’s death.
“There hasn’t been a dispute. Aji has followed the doctor’s recommendations from the beginning,” Godkin said. “We wish there was something new that could help.”
Godkin said Aji was prepared to call witnesses who would testify that Sam had said he never wanted to be kept alive on life support. “Unfortunately, there was no Advance Directive,” Godkin said.
“That’s the big lesson to all of us.”
Sajan, who also has been in Austin since his older brother’s hospitalization, believes an experimental stem cell therapy that he said benefited a patient in Miami might also help his brother.
“I want six weeks done so the brain will heal by itself and then go to the stem cell treatment in Miami or some other facility,” said Sajan, adding that he also offered to take over as caregiver.
Godkin said he has seen no evidence of a possible treatment, and asked that if there were one, why wouldn’t the local doctors pursue it?
Sajan’s lawyer, Sandy Bayne of Austin, said she couldn’t speak to the treatment but asked, “Why this kind of rush?”
“I had six or seven letters saying he was a fighter and loved life,” Bayne said. “I had cousins driving in from out of town, showing me text messages in which he said, ‘Now that I am separated from Aji, I am so happy.’”
She said she believes Sam’s son was acting under his mother’s influence.
Jonathan’s lawyer, Wesley Prewitt of Austin, said his client is “very responsible, and he is not taking this lightly.”
“He is aware of all of the family’s thoughts and concerns, and he’s relying on the advice of doctors,” Prewitt said. “He feels he knows what his father wants. Beyond that, it’s just a very personal matter.”
Godkin said he does not believe anyone in the case was acting with ill will. “People think what they are doing is best. That’s why these cases are so contentious. It makes it so difficult because you have all of these raw emotions.”
He also got a wakeup call. Godkin said that by the end of next week, he’ll be filing his own Advance Directive.
Update: Sam Varghese died at 9:10 p.m. Friday at University Medical Center Brackenridge.
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Wrenching case of man dying in Austin hospital spurs feud over care