Sorry no cowbell here, Igor hates when I play that thing anyway (Master has the rhythm of Helen Keller…). It’s as bad as saying Bleucher. Missing that whole vampire theme, I know. Speaking of death and dying, it is time to have an honest conversation with yourself, what are your plans if you stop breathing or your heart stops? Have you thought about that? Does your significant other or someone know your wishes should that happen? Is this in writing, like officially? If it is not, why not?
In 1990, Terri Schiavo, who was 26 years old suffered cardiac arrest in her home and was successfully resuscitated. However, post-arrest, she remained in a persistent vegetative state. While she and the husband had “talked” about end of life issues, nothing was ever formalized. An effort was made to return function, yet it was finally abandoned in 1998. After that, it was a back and forth battle to sustain her life, even in the absence of higher function evidence. Her parents did not want her to die, and the husband remained adamant that she was being kept alive despite her wishes.
This family divide lasted seven years after that. Congress and even President George W. Bush signed legislation moving her case to the federal court system in the hopes that they would keep her alive. In the end, all life sustainment measures were removed, and she died thirteen days later. This story gripped national attention at the time, and both sides came out with strong statements urging loved ones to talk about end of life issues. If anything came out of this, that was “good”, this was it. Talk to your loved ones and write down those wishes. I am quite sure that Terri Schiavo thought it could wait.
I know you all think that talking about dying or listening to Nursie poo bring up the topic is so gruesome. Yeah, it is. There is no nice way to phrase such an important discussion. Do you want to end up like Terri did? Let’s talk about that for a minute. Terri was unable to feed herself post-arrest. Eventually, a J tube was inserted into her stomach to feed her. Before that, she had a feeding tube down her nose. The J tube is more permanent and would remain with her until her death. She received both tube feeds (think ensure without sugar) and water through that tube; that is how she was kept alive. She required 24/7 care. She wore a diaper and was incontinent since she was unable to indicate that she needed to go. She had urinary tract infections from the incontinence and had to be manually repositioned. Skin care was also an issue and break down may or may not have occurred since bedsores occur when people have to stay in their waste until changed and cleaned and happen due to pressure from laying in the same position. Even in the event of regular repositioning, they can form because the skin does break down over time with the amount of laying and the consistent exposure to human waste. At any point, her care was intense and extensive. That is not to say she did not deserve it that she shouldn’t have had it (if she wanted it), but it is saying that this is not the most dignified or gentle process.
Backing up (Always with the poop jokes, Master…), cardiac arrest is not what it looks like on House, Gray’s anatomy, or other medical shows. When CPR is initiated, it usually causes the ribs to break or separate from the sternum. CPR requires a compression of 2 inches at 100-120 times a minute. This is significant force, and post-arrest survivors will tell you that recovery is painful from compressions alone. A tube is inserted in your throat to your lungs to help you breathe. When you are defibrillated, you don’t magically come back like on TV. It is usually a litany of compressions, shocks, drugs, and a lot of sweat. If you are “lucky” enough to survive, there is a road to recovery that is not as easy as you would think. There would be broken ribs, burns from the defibrillator, and then there is the internal reason that your heart stopped (yeah CPR doesn’t fix that). If you are lucky, you will walk out of the hospital to a semi-normal life. If not, well you end up like Terri or in a similar state. Being without oxygen and circulation for more than 4 minutes can cause brain damage.
Ok, you have some pretty good info here. If you say, “so what, I want my life saved.” Well, then do nothing. Medical professionals will do everything they can to keep you alive that is within their power. We are trained to save your life. We are also trained to let you go or to honor your wishes anywhere on the spectrum. You must tell us, and you need to make it clear. A Durable Power of Attorney for Health Care will let providers know who you want to make decisions for you if you can’t speak for yourself. They should know the ins and outs of what you want to be done.
A living will require no one to make decisions for you. It says if something happens, these are the steps I am ok with and these are the things I don’t want. It is much more definitive and gives everyone a clear picture.
If something changes, you can change this at any time. I will tell you that I had a man who did not want to be intubated until he couldn’t breathe. As we started to apply oxygen, he withdrew this part of his living will and asked for the tube. It’s your life, and it’s not set in stone.
As your provider, I am here to help you live as long and as fully as you are capable. I would not have been happy to have been Terri’s PCP, just because of the confusion and animosity. Take a chance and read about it. It is scary the lengths that both sides had to go to, and they are still bitter to this day. I will always ask about this because you should not have the brunt of lifesaving techniques used if you don’t want them. Sometimes just letting go is the best. I will not lie, this is difficult. I have watched people who just decided it was time to go, go. This was done at home with their family near and someone with them as they passed. Death can be as beautiful and peaceful as life. It is tough for me, and I often have to quell my emotions. My patients deserve the right to go in peace or to fight it out. I am not that decision maker, nor should anyone be except the patient or someone they agree to speak for them.
Well, one hound is snoring, and another wants to snuggle. Off to that my lovelies. Until next time.