"When you get those rare moments of clarity, those flashes when the universe makes sense, you try desperately to hold on to them. They are the life boats for the darker times, when the vastness of it all, the incomprehensible nature of life is completely illusive. So the question becomes, or should have been all a long... What would you do if you knew you only had one day, or one week, or one month to live. What life boat would you grab on to? What secret would you tell? What band would you see? What person would you declare your love to? What wish would you fulfill? What exotic locale would you fly to for coffee? What book would you write?"

Wednesday, October 13, 2010

The "Forbidden" Euthanasia Topic

So every class that I seem to have in Nursing school, we always come to a point in the class where we address End-Of-Life issues. In Foundations it was how to do post-mortem care, and how to approach death and dying, and how to approach grieving families. In maternity it was mothers and babies....what happens, how do they die, how to prevent it, etc. In my Ethics class we tackled the big topic- When to let them go? How long do we fight? Living wills, advance directives, what to follow? In Med/Surg (now), it is all about how people die...and its scary because there are a bazillion ways. It's interesting because I watch America's Funniest Home videos and its remarkable how many injuries are on that show, and half the time I see someone fall in the video sent in, and I think, Ouch! Thats a spinal cord injury! Or, Ouch! thats a concussion. Or, wow, they better keep an eye out for increased intracranial pressure....there are so many ways someone can die that its a wonder we stay alive with everything that is thrown at us. Diseases, cancer, bacteria, viruses...injuries, falls, car accidents, violence, gun shot wounds...etc. But we survive. Sometimes. Sometimes nothing happens and we walk away from car accidents scrape-free. Or we get shot and it hits no vital organs.

Then there are those people that don't make it. Don't recover. I have had a ton of experience with death, mostly at work. This summer I walked in to a room and the family asked me to verify if she was dead or not...she was. I did my first post-mortem care when I was only 18. I have had over 50 deaths, I would guess. I have seen people take those last breaths.

In our country, we fight. We fight for our survival, its in our blood. We fight diseases. Doctors fight bacteria, viruses. But how much is too much? People go through so much to survive, and even so some will never get better. Elderly people that fall ill that never expressed wishes beforehand, and resusitated and intubated and kept on machines, sometimes for months. BIllions of dollars are spent just keeping people alive on artificial machines. They are suffering. Some are afraid to give up...some have families that are afraid to give up. Some don't know how to say to themselves that they are facing death.

I recently had a friend of a friend that lost his uncle from an inital injury and a long term battle of disability and illness thereafter. In trying to make both friends feel better I made a comment, "At least he had the kind of death that he knew it was coming and his family got to say Goodbye. Isn't that better than losing someone you love in a car accident?" when the last words you said were "Can you pick up some milk?" or "Don't be late to Jenny's soccer game?"...

But then I thought about it in silence. Which is better? When a patient and their family member(s) find out they are going to die, the grieving process begins. THey either start fighting or start...living, and dying. But it has begun, and the death looms in the air for as long as the patient lives. The sickness causes suffering, pain, unpleasant living conditions (chemo?), and the patient is unhappy...to gain what? A couple more months?

Don't get me wrong...I am all for fighting, for giving everything the medical community can offer if the patient can make a full or almost full recovery. THey will get better. Maybe a baby that has a life to live yet, or a teenager...or a parent, or even the elderly. If they have life to live yet and will get better. "Better" means a lot of different things to different people. Some people refuse to live if they can not go on their run every day, or walk. Some would go clinically insane if confined to a bed. Some end up stuck in a coma. Some have mental disabilities (stroke, hypoxemia, heart attack...). Those things might be too disabling for some to be happy, others not. Some would stay perfectly content living in a bed if they could watch tv all day.

I believe in the mind. My opinion is that the mind, to me, is most important. I would not be able to live without my complete mind. THat is worth living for, for me.

I don't believe in prolonging people's lives if they are never going to get better, or if they are going through pain, unesscessary pain, just to continue living for another month. During the last couple months, they should be enjoying themselves with their families, at home. Die naturally, that is what I stand for.

Dying naturally beats living artificially.

But I am too afraid to voice these opinions in my nursing classes. If i try I get these odd looks, mostly from professors that think I am all for Euthanasia and cutting living cords prematurely, the next Cullen case. I'm not. Cullen ended people's lives prematurally because he thought their life was not worth living for, that they were living artifically or for no reason. He ended peoples lives against their will, before they gave consent to be ready to die. That was not in his power, nor would I ever intentionally kill someone because they wanted to die, or because I thought they would be happier dead. So I don't want professors thinking they shouldnt pass me because they think I will be the next Cullen nurse. I stand for being happy when you die, to die naturally, to let life take its own course and die at home with your family, when your body is ready.

I would like to end with this great quote, "The simple view is that medicine exists to fight death and disease, and that is, it's most basic task. Death is the enemy. But the enemy has superior forces. Eventually, it wins. And in a war you cannot win, you don't want a general that fights to the point of total annihilation. You don't want Custer. You want Robert E. Lee, someone who knew how to fight for territory when he could and when to surrender when he couldn't, someone who understood that the damage is greatest of all if all you do is fight til the bitter end." Atul Gawande- "Letting Go". **

THat sums up exactly how I feel. You Kill more soldiers if you fight a war you can not win, to keep them fighting until there are no soldiers left. I understand that some say, 'but you can't just give up...you have to stand up for what you are fighting for.' we just need to take a step back and think about what we are fighting for.

If you would like to read the very good article:

Ta ta, thanks for reading my depressing topic choice for this evening... night!

~ A writer in a nurses Body.

No comments: