with dignity

being in the intensive care unit has brought end-of-life issues back into the spotlight for me.

this article by ken murray has been making its rounds on facebook over the last couple of months. the author has not only very eloquently expressed how i’ve felt about death ever since i knew my grandfather described CPR as the worst pain anyone could be subjected to, but also drawn attention to the fact that so many different factors contribute to how a terminally ill person lives out their last moments on earth.

murray wrote:

“One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack’s worst nightmare. When I arrived at the hospital and took over Jack’s care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack hadn’t died as he’d hoped.”

a couple of weeks ago, i encountered a woman whose heart was so damaged by chemotherapy that it was barely functioning. she underwent surgery for a strangulated hernia, got better for awhile, then deteriorated. after lengthy counseling by both the primary and intensive care teams about her prognosis, her family opted for intubation and intensive care, but not any other forms of active resuscitation. although their intentions were for her to hang on until her father could bid her goodbye, she passed away not long after she was brought into the icu.

part of me was angry that she was subjected to an invasive procedure, an unnecessary transfer and a possibly painful last couple of hours alive. her family’s decision for intubation and ventilation support but nothing else felt…confused. ill-informed.

but another part of me empathised. i wasn’t there when they were counseled on what intensive care meant and how it would (or wouldn’t) affect her outcome. maybe they didn’t understand, or their judgement was clouded by grief.

or, as murray wrote:

“The problem is that they may not know what’s reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them.”

it seemed like a confused decision because it was exactly that – a confused decision. i can’t even bring myself to think about whether it was right for us to comply in the first place. it gives me much too big a headache.

anyway i’m just going to continue being an open book and put it out right here: should i ever be stricken with a terminal illness for which treatment will only stand to prolong my suffering, i do not want to be subject to any active resuscitation. harvest every part of my body that is fit for donation even if my family refuses to let you. i want the only thing left of me is the memory of the (hopefully) good things i’ve done.

that’s how i want to go. perhaps that is the best way to go.

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