Death and Dying

One of the doctors that I work with asked me to help her pronounce a patient dead. This involves doing a number of tests on the patient to be sure of death; listen to their heart and lungs (that aren’t beating), touch their eyes (that won’t blink), touch the back of their throat (that won’t cause a gag), and rubbing hard on their sternum (and they won’t try to stop you). This was all very academic while we did the tests, but after we stopped I had a second to myself with the cadaver to think. The very next week we had a lecture on Death and Dying. These two experiences got me thinking about death. Despite the fact that everyone is going to die, our culture is very far removed from death in our lives and most people haven’t ever seen someone die. Advances in medicine also help us live much longer and gives us a mini-delusion that medicine can cure just about anything. Sometimes, however, this prolongation of life is done so at great cost to the patient and with very little quality of life. We have a patient in the ICU that has advanced ALS (Amyotrophic Lateral Sclerosis AKA Lou Gehrig’s disease – You eventually lose all muscle control in an ascending pattern, but your sensation is still intact. Eventually people die because their diaphragm muscles gives out and they can’t breathe. It’s a terrible disease and a terrible way to die). He is now almost completely incapacitated. He has a ventilator breathing for him, he’s on a bunch of antibiotics because of infections, he has a very large bed-sore ulcer on one of his calves from having it lie on the bed without moving it, he is fed through a tube, he has an enema every other day to produce bowel movements, he has a catheter for peeing, and IV fluid because he can’t drink. The only thing that he can do is blink, and only sometimes at that. Should we continue to provide support for him despite the fact that he has 0% chance for recover or improvement? Should we discontinue treatment? This really isn’t my decision to make for him, but I do think is that people need to do is to come to grips with the fact that they will die and decisions need to be made concerning it. We can’t always control how we die, but there are some aspects of death and dying that can be dealt with and communicated to loved ones before they happen. In case anyone wondered, if I’m dying, I would like my family not to prolong my life by hooking me up to lots of machines but to let me die with dignity and peace