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Life & Death.

Wednesday, December 23, 2009

This post will surely be controversial. So be warned. It is not a happy, Christmas-y post. A part of me debated whether or not to even share this. But, in the end, I decided I would.

It is, indeed, a controversial topic. And, I’m okay with that. I figure, this is my little space of the blog world so I will say what I want;

Controversial or not.

In my line of work I come across quite a bit of controversy. And believe me, that’s putting it nicely.

There are some instances in which I just let it roll. I try my hardest to let it go because if I take in every single little thing that bothers me and let it get to me it will eventually eat me alive.

Alas, there are something’s that really ‘yank my chain’ so to speak. They eat me away no matter how hard I try to overlook them. Even though the decision isn’t mine to make, I still let it bother me.

There is a pretty narrow balance between life and death, believe it or not. I’ve had the pleasure (or displeasure?...depends how you look at it)to help strike that balance to keep the patient alive and most importantly enjoying life. But, in some situations,* when the latter of the two seems imminent I don’t believe people should be kept alive just to be just that…kept alive.

* I am in no way referencing everyone. Especially children and young adults. Children and young adults are amazingly resilient. Children and young adults (in my humble opinion) should have every single option exercised (and then some) to keep them alive. Miracles do happen, everyday and they are incredibly resilient.

During my clinical experience (and during other times in the hospital, such as my time spent shadowing recently in the ICU) I have seen multiple patients who have either expressed their desire to “stop fighting” and die a dignified death, or, they’ve had a stroke or another major incident and are clinically brain dead with absolutely no quality of life and they’re family (because the patients are deemed incompetent) wants every stop pulled. They want them to have a full code status, tubes inserted into every orifice (sorry to be so blunt), invasive procedures performed and every conceivable medical intervention performed just to keep their family member alive…

and for what?!

I’ll tell you what: it really makes me wonder. Is it because they really believe a miracle will occur and they’re brain dead family member will miraculously be healed? That the cancer will just up and disappear? The infection that has raided their body will completely reverse itself? Most likely not. That may be what they tell you, but I beg to differ. I firmly believe, in most cases*, they are doing it for themselves. Not necessarily to be blatantly selfish, but basically that is what it comes down to. This is where I draw the line.

This is where it starts to hit me on a deep, personal level. When you find yourself questioning wether your family member would want to be kept alive int heir current condition please question yourself: are you being selfish? Is this really fair to do to someone you love so deeply?

*Don’t get me wrong. I believe in God’s miraculous healing powers. There is though, a practical, scientific side to me as well. I mean c’mon I’ve been through my fair share of science classes and there are some instances (usually in reference to older or compromised patients) where it is next to impossible for the patient to be healed, no matter how hard it may be to accept. Maybe, just maybe this is God calling that person home, maybe it is their time. And that is why God is giving them such dismal odds. He wants them home with Him.

And you ask why this is such a personal, touchy subject to me? I experienced it first hand, that’s why. I was privy to the many conversations both at our local hospital and Yale as to whether to place a “DNR-Do not recessutate” and “DNI-Do not intubate” order in my dad’s chart. Don’t get me wrong that is a tough decision to make when you are already so worn down from the everyday mundane tasks of continuing to live your life while having a seriously ill family member in the hospital. But, am I ever thankful that we did have these talks with my dad while he was with it. While he was able to give his two sense because, we listened. We have always been a relatively “open” family. And these instances at the hospital made me forever thankful for that attribute of my family.

Also, we did have to make the heart-wrenching decision to “pull the plug” so to speak. It was in absolutely no way easy and the decision didn’t come lightly, in any sense of the word. We sat and we talked, as a family, with the rational input of the doctors and we came to the decision that keeping my dad alive any longer would be only for our benefit. Because, he was not there any longer. His body was just his shell. We prayed and we came to the decision that this is what Dad would want. He would not want to be kept alive by every mechanical mean possible just to have a beating heart, functional lungs and mediocre organs with absolutely no quality of life whatsoever. The decision was made and I can say, with out a doubt, that we followed my Dad’s wishes. And that is something I am thankful and proud of.

Now, I totally understand that not all cases are as “cut and dry” as my Dad’s was. My Dad was a sick, actually a very sick (at the end), man. I understand that sometimes patients land themselves in intensive care units because of truly, unfortunate accidents and you may not have had the time to sit down and have the deep, intense conversations that we had the privilege to have with my Dad before things got really bad. And those cases, in my opinion, are the most unfortunate of all.

That is where my last point comes in. I know theses aren’t my decisions to make for you and your family (whoever may be reading this…) and usually aren’t my place to queue in with my humble little opinion. There is one thing I do ask though: Determine what your family wants and get it in writing. I don’t care if you are the healthiest person on planet Earth. Accidents happen, everyday, to anyone, and, believe me they do not discriminate. Sit down, have a heart to heart with those you love most. Find out the nitty, gritty details. What they want to have done, what they don’t want and under what circumstances. Talk before the times get tough, before these conversations are actually a necessity. I can’t express to you the complete importance of up-to-date living wills. It may not be easy but it is so important. It really is a matter of life and death.

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