“Doc, take good care of me!” This was an interesting thing to say to me since this man had just attempted to take his own life with a single gunshot through the liver. I promised him I would do my best as the anesthesia began to take effect, and he drifted off to sleep. Things did not go well. As days turned into weeks, the family had to wrestle with the decisions of what to do when it became painfully obvious to everybody that, even if he survived, he would be a shell of his former self. They made the wise decision to withdraw care. Although nothing could have made that decision easy, the hurt feelings and guilty consciences that followed could have been avoided with proper planning.
As a surgeon, I have the privilege of saving lives, improving health, and alleviating suffering. Most of the time, thankfully, I am able to assist in some meaningful way and improve the number and, more importantly, the quality of the patient’s life. But there are times when a person can be ill or injured beyond what we as physicians can treat. It’s an obvious statement, but everybody dies at some point. The prudent will prepare for this.
As I read this article, I couldn’t help but think of the many people I had encountered over time. Some dying well. Some dying poorly. Some assisted by their families. Some encumbered by their families.
Possibly, the most important point that this article conveys is the futility of cardiopulmonary respiration (CPR) in most settings. The movies routinely perform resurrections as though it were a normal occurrence. This is usually not the case. CPR is life-saving in certain situations. Electrocutions and near-drownings are perfect for CPR. The person is usually young and healthy. If the circulation can be restored, the person can often return to a normal life. An elderly person who’s heart has stopped due to the ravages of end stage cancer has a near 0% chance of doing well after CPR.
This is where doctors and the general population will often divide. As usual, context is everything. If you can catch me minutes after a direct lightning strike, feel free to pound away on me. If I’ve been suffering for years from heart disease and you find me face down, please let me go in peace. This contextual disconnect is often the big difference.
There are many ways that a person prepares for their eventual passing. Life insurance protects the family in case of the untimely death of the income earner. Wills are in place to ensure that a persons wishes are fulfilled at the time of their death. Perhaps the most important thing to consider are advanced directives, which are utilized too infrequently in my opinion. Of course, no advanced directive can consider all contingencies, so a medical power of attorney to a trusted person is also critical.
In the end, preparation, forethought, and communication is absolutely necessary. If at all possible, don’t leave your family with these agonizing decisions. Prepare for it by telling them your wishes. This is a difficult but necessary discussion. If this is new to you, why don’t you start here with the website Engage With Grace. This could be one of the most important conversations you ever have with your family.
Please share your thoughts and stories.