Life and Death… What would you do?

I have a lot of fun, hopefully interesting and much less serious things to blog about (and absolutely no time in which to do so), but I read something on a friend’s page today that got me thinking about this.

Said friend just got back from the hospital after a scare that involved chest pain. Nothing conclusive was shown (that’s a good thing) and returning for another test (right away) was recommended.

This got my friend thinking about what she would do if it turned out to be something serious enough to require invasive surgery such as a multiple bypass; (an uncle had one) Would she, at her (retirement) age put herself through such an invasive and recovery intensive procedure such as that, or accept that life is finite and just go on about the act of living?

Hopefully, it is tendon/muscle/ligament and/or irritation of the pleura or pericardium, perhaps/most likely something that is easily fixed by a shot of antibiotics, some mild medication or just rest and recovery and this will all be a mute point for my friend.

Since my cancer scare a year and a half ago, I’ve thought a lot about such things.  What would I do if it it was ovarian cancer?  Would I have chemo?  Would I accept localized radiation?  Or would I just tell everyone I love that I love them, live my life with as much zeal as possible and then go into hospice on a morphine drip when that was no longer possible?

I’m pretty sure that in that case, I would chose the latter. As a matter of fact, I am as positive as one can be without actually having to make that decision.

Like my friend, I do not have any children relying on me; if I did, I would most likely feel a different responsibility to them.

During that time, I also watched my close friend Houston battle stage four prostate cancer.  For a year and a half after the diagnosis (when they told him he only had a short few months to live) he was mostly confined to bed in a nursing home and was in and out of hospitals for surgeries and complications of his disease and treatment.

He fought; he fought valiantly and up to the end remained positive and determined to beat it.

With my medical background, I knew that the prognosis and the likelihood of that happening was so miniscule that statisticians would not be able to quantify it. Granted, I have seen miracles, but did not really expect one in his case.

But this was his fight, not mine, his decision, not mine, HIS… NOT MINE. As long as my dear friend wanted to fight, I would be there with him, holding his hand (even when it required a gloves, gown and a mask to do so) and would support his decision 110%.

I know death. I know death all too well. In addition to having danced with it myself on more than one occasion, I have been with people when it came. I have seen the beauty and peace one feels when ready to end the pain and pass over, I have seen and felt the horrible struggle of those clinging to life they were not ready to let go of as it was traumatically torn from them, and I, as as medical professional have had people beg me to let them die in peace with dignity when the law would not allow it. That is the most heartbreaking thing of all.

So while my friend pondered what they would do and I watched mutual, concerned, loving friends beg, plead and demand action, I remembered a choice I made a year and a half ago.

A little known fact about surgery, about general anesthesia. More people die from general anesthesia, than from the illnesses and injures that require the surgery.

When I went in for my first surgery a year and a half ago, I updated my will and my advanced directives.

The most difficult choice, was finding someone to carry out those directives.

I needed someone (and a backup) that “loved me as much as they loved their dog”

That sounds weird.

I needed someone that loved me enough to pull the plug should things go bad.

I could not choose anyone whose religious beliefs would preclude them from doing that.

We take our beloved fur children to the vet and have them “put out of their misery” when their short lives are going to be filled with nothing but pain, misery and suffering, yet only in Oregon and Washington states, do we have a death with dignity law in which we can make that choice for ourselves.

Whilst that choice would be made by only me and my doctor, well ahead of time, the idea behind it is the same.

Do you love me as much as your dog?

Do you love me enough to pull the plug and end all of our suffering?

Luckily, I have dear friends Janet and Betsy who agreed to do that for me should it come to that.

My advanced directives are clear…

WHAT! You don’t have advanced directives?

Fill them out, have them notarized, DO IT NOW!

Having worked in emergency medicine for well over a decade, I (and most, if not all of my colleagues) would prefer to just have “no code” tattooed on my chest.

Since that is not an option, my advanced directives are clear.

No respirator, no feeding tube. If I can’t be brought back with basic CPR and a zap with a defibrillator, save my loved ones and the staff the hassle of trying to bring me back from a vegetative state.

You see, the brain dies after 4-6 minutes without oxygen. You can “save” someone and get their heart beating again, but it does not mean that they will “live”

As a paramedic, I experienced this far too often.

The expectation, the legal mandate was to “save lives”.

In the absence of “no code” orders signed by the patient and the physician (and not expired), at the bedside, we were required to do what we were trained to do.

Yes, it sounds exciting and exhilarating to bring someone back from the dead and get their heart beating again.

The harsh reality is, that in most cases, they “come back” brain dead, only to code over and over again in the ICU as their family mourns their death many times over, and is driven to bankruptcy in the process, or they “live” in a vegetative state in a nursing home being fed through a tube and have their diaper changed by underpaid staff.

I cried far more often for the patients I “saved” than the ones I lost because I did not feel like a hero, I felt like Dr Frankenstein, only prolonging pain and suffering.

I am not afraid of death. I’ve been clinically dead once as a child with a severe allergy/asthma attack brought back to life with an intracardiac injection of epinephrine and as an adult made peace with the fact that the most likely scenario is that I was going to die after a river guiding accident that fractured my spine and pelvis.

and please in the name of all that is sacred to you, harvest my organs and give them to people who need them. What! You don’t have an organ donor card/endorsement on your license? If you are so inclined DO IT NOW!

What I am afraid of, is having a stroke or an accident and not having a choice, putting my friends and loved ones through hell on earth and being a drain on the system.

But back to my friend.

I fully expect her to live a long and productive life and have strongly recommended that she get back in for the tests ASAP. After all, you can’t make a decision if not given all the information you need in which to make it.

But if for some reason, that is not the way it goes and she makes a choice not to undergo something so invasive.

I support her decision.

I will be there for her.


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