Mrs. J. was a lively independent 89 year old who lived life to the fullest. She had no way of knowing of the aneurysm, sitting like a time bomb on the surface of her brain. When it exploded, a layer of pulsing blood rapidly enveloped her brain, threatening sudden death. But Mrs. J was stronger than that. She had laughed off far worse challenges in her life and lived to tell the tale, a smile on her face. But this time she would need some help. The ambulance rushed her to the hospital as she hung on to dear life by a thread. The medical team rapidly found the problem and, in a miracle of technology, knowledge and compassion, sealed the aneurysm off. From the inside, through her blood vessels themselves. The tiny metal coil was expertly delivered through the road map of her arteries, the destination found: a pulsating blister on the side of a cerebral artery. No more would that aneurysm threaten to take her life. All that was needed now was time. Time to allow the brain and the body to heal.
She would not arouse…Her life was gone; taken from her. Taken by the drugs supposedly given to her for “comfort”. In reality, taken by the hardened hearts of her family and doctors who no longer respected her value nor had the courage or will to fight for her life. The only comfort given was to those cold, unfeeling hearts.
She lay in the unit, fighting back and winning. The plastic tube and ventilator deliver life-giving oxygen to her lungs and remove the dangerous carbon dioxide. Breathe in. Breathe out. Another technological wonder as her bridge to life. Her heart was assaulted by her condition and nearly gave out. But still it beat on, delivering the oxygen supplied by her ventilator to her recently saved brain and body. For days she battled, her doctors and nurses as her allies and champions. When asked “can you hear me?” she would nod, her bright eyes piercing the questioner. When commanded “show me two fingers” she complies quickly, making a peace sign. Her brain and her body were holding out. Another victory close at hand. But wait, asks the family, would she want this? Would she want to live “like this”. No, they decide! It is all over. Somehow they don’t see her nodding to questions. They don’t see her grabbing her clothes. They only see their mother in what appears to be a struggle as she moves from one side of the bed to another. They don’t see her as vanquishing death but as a helpless victim. It is time, they decide; time to “let her go”.
The medical team advises them, wait! Give her a chance. This is a bridge she is crossing. She is not dying, she is living. She is fighting and winning. She is thriving. She will almost certainly have many days of life where she will remember her victory over death, hug a grandchild or perhaps just admire the flowers. “There is no ‘quality’ to her life”, they say. “Listen please”, the doctor begs, “she is on a journey”. The doctor proclaims, “She is living, not dying; let’s give her a chance”. They have ears but do not hear and they harden their hearts: “no, you won’t change my mind” they say, “she is 90!” If she can live without the machine, then so be it, but she wouldn’t want to live “like this”, they say.
The doctor wonders. Maybe they don’t know? Maybe they haven’t seen? He brings them to the bedside. Look! “Betsy, do you want us to keep going? Should we try to get you though this?” Mrs. J. nods her head, demonstrating she is awake. She can make up her own mind if given a chance. They have eyes but do not see and their hearts grow harder. A decision is made: remove the machine. Keep her “comfortable” only. The doctor leading the charge for life tells the doctor about to remove the machine: “please, don’t give her morphine”. Let her breath. Give her a chance. She will show them all. She can live. The pro-life doctor knows that if she is awake and he can talk with her, she will decide what course to take. She will again be in charge of her life. The tube is removed. The night passes. The doctor fighting to save her life saves another as the night passes. The morning comes and the doctor excitedly comes to her bed; ready to talk.
Lifeless she lies, eyes closed, chest rising with imperceptibly small breaths. “Wake up” the doctor rubs his knuckle hard on her chest. Nothing. She would not arouse. The morphine was given every two hours, along with a sedative. For “comfort” the doctor is told. The doctor knows better. “She was becoming agitated” is the report “we are helping her not suffer”. The doctor knows that the medicine is not used to comfort the patient. Not to relieve pain the patient is feeling, but to calm the person fighting for life before our eyes. To keep her from having her chance to say: “I LIVE! THANK YOU! I WILL KEEP FIGHTING!” The drugs are removed by this doctor, but it is too late. She dies within hours, the lack of oxygen and the buildup of carbon dioxide conspiring to wage their final assault on her fragile brain.
Her life was gone; taken from her. Taken by the drugs supposedly given to her for “comfort”. In reality, taken by the hardened hearts of her family and doctors who no longer respected her value nor had the courage or will to fight for her life. The only comfort given was to those cold, unfeeling hearts.
These stories will become more commonplace as the government and corporate takeover of medicine proceeds through Obamacare. The hospital is on a budget. The doctors no longer fight for their patients. As hospital employees, they feel they have a greater duty to “protect the resources of the state”. Doctors may feel powerless when confronted by a family that demands to end care, when they should stand up strongly and refuse to do so when a good chance of life remains. Families of patients have been brainwashed to give up too quickly and to value a perceived “quality of life” over life itself. They may close their eyes to the realities of what medicine can accomplish or some may have other issues motivating them that aren’t in the patients best interest. As doctors, it is time to decide in which direction we will take medicine – as champions of the patient or as resource managers.