I have come to think that the Fat Man was right. And Jo, possibly, was an idiot.

Emergency physicians are being confronted with increasing numbers of geriatric patients. Now, I love my geriatric patients. They have the most interesting stories about better and harder times alike. But I sometimes wonder if they would be healthier and happier if we didn’t do everything we do for them.

Those of you who have read Samuel Shem’s classic The House of God might recognize some of these questions. For those of you who haven’t, find a copy, STAT.

In The House of God, the patients get better without the life-saving treatment from Man’s Best Hospital. Law Number One of the House of God: “GOMERs” never die.

We see those “GOMERs” every day: demented nursing home and hospice patients who don’t know their families or the day of the week. We find ourselves putting in central lines and rectal tubes and pumping on their chests because their families want them to be a “full code.”

When I was a resident, I had a patient I’ll call Frannie. It was April, and she had been there since February. No matter what I said to her family, she was always a full code. This poor lady had a trach, a Foley, a rectal tube, a gastric tube, an arterial line, and two central lines. She was 91. Whenever I spoke with her daughter regarding code status, I kept thinking, “What? Was she a bad mother?”

We don’t do all of this to people for their benefit. In many cases, we are doing it for the family members, who aren’t willing to let go yet.

At some point we need to realize we are doing things to people, instead of for them.

It’s like when in The House of God, Jo does a dementia work-up on a 95-year-old woman, including scans and a spinal tap. “I deliver medical care,” she keeps saying. “And that does not mean doing nothing.”

But I think that in some cases it does. We need to remember primum non nocere, or first do no harm.

Every day, we see the hospice cancer patient, the CHF patient, the end-stage renal patient, their families opting for every intervention possible. How barbaric is it to pound on their chests with compressions, crack their ribs, and shove tubes down their throats? Will the Foley catheter we order for the ease of the nurses condemn the patient to die of urosepsis because the nursing home staff never changes it?

I’m not suggesting that once you reach a certain age, you aren’t worth saving. Absolutely not. I’m talking about dying with dignity, or at least living with some.

Several years ago, my grandmother was diagnosed with a crappy aortic valve, and she goes into CHF exacerbation every few weeks. She’s 87, on home oxygen 24/7, and sharp as a tack. When I visit, it always involves a trip to the casino with her walker and oxygen tank in tow. She doesn’t go as often anymore, so now she plays casino games on an iPad my dad bought for her.

Recently, she’s been getting worse. The decision about having her heart valve replaced looms, and she has said adamantly no. She’s not saying no to life or a cure. She’s saying yes to her life as she knows it. She’s saying yes to going to the casino every once in a while, yes to getting around in her walker, yes to hugs from her grandchildren.

She knows that not only may she not survive the surgery, but all the things she loves to do might come to an end, too. So for now, she’s said no surgery. We have to ask ourselves, if I were that age, would I want that for myself? Daily I see families making decisions for their demented, terminally ill family members that they probably wouldn’t want for themselves.

The Fat Man makes sense when he says people get better when you do nothing to them, with to being the operative word. Maybe we should think about doing things for them. Flowers and a smile are always nice.

Dr. Bundy is an attending physician at ERMed, LLC, in Montgomery, Ala.