Tuesday, February 26, 2019

A non-morbid discussion of death and dying

Aesop ponders death, what it looks like from the trenches of the Emergency Room:
Unless you buy it after an IED explosion, or going out like Quint in Jaws, death mainly hurts the friends and family. 
No one ever woke up during a Code Blue and said "Ow!". They were over it, and generally speaking, long gone and well past caring at that point. 
And if they've had their threescore-and-ten, or more, it isn't really necessary to "compartmentalize" their death; someday, it's going to be everybody's time. 
The hard ones are the way-too-early ones, especially kids and infants. No one pulls the plug on those for an hour or more, because kids.
This is a long and thoughtful post, inspired by a post at OldNFO's place.  I'd be interested in the opinions of Tacitus, a retired ER doc who is a sometimes commenter here.

Interestingly, I didn't find any of this very morbid.  It did make me think of  Dad's funeral, but that was (as you can imagine) intensely personal and so had a very different emotional component.


Pachydermis2 said...

Well, I no longer go by Tacitus. When I was working ER I figured a real name internet presence was not prudent. You don't want people in the waiting room googling up your musings.

I worked as a Family doc for 20 plus years then primarily as a small town ER doc for another ten. There was less distinction between the two than you'd expect. Lots of the ER stuff should have been seen in clinic. And even in the clinic years I tried to see our group's patients in the ER.

In my ER role I actually lost exactly one patient, if by that you set the standard strictly that they check in alive and die in the department. And he was over 90, having a big MI and I still almost pulled him through.

I was some combination of lucky and good back then.

But you have to exclude No Codes, who have thought this scenario through already, and the ones who frankly arrive dead. And out of hospital arrest is generally a synonym for dead.

I was pretty good at helping families see this. Sometimes it involves pulling up that CT scan that shows the bright plume of a massive bleed that is crushing the brain. Sometimes it is just telling them honestly that this combination of age, underlying organ dysfunction and length of resuscitation is such that "if" you got them back it would not be the person they knew. And I asked them as decision makers, based on you knowing this person, what would they want you to do?

Some people were not ready for that call. No problem, there is no Right Answer. Call the helicopter and keep the ventilator going and the meds to sustain blood pressure dialed up. Families sometimes came back and said they wished they'd decided otherwise.

In a job where failure is total (in the sense that 100% of my patients would die....just not on my watch tonight!) I of course had a handful of cases of the years that I will always remember.

It was a tough job. I put a lot of myself into it. It took a lot back out. I burned out just short of 60. When you know it is time....then it is time. I handed the burden to others.


ASM826 said...

This is a topic She and I have frequented in the past few years. Here's our current thoughts on it. It's from a Buddhist site, but there are Christian lines of thought that are very similar.


For both our own lives and those close to us, seeing death as bad sets us up for an extra dose of grief. Accepting death when it comes without judgement allows for reality.

Old NFO said...

Thanks for the link, and no, there is no 'right' answer...

Aesop said...

Your death is your own.

Face it within the dictates of your own conscience in whatever manner seems best to you.

You're mainly a passenger on that journey anyways.

Best cinematic treatment ever:
The Lion In Winter, Anthony Hopkins' line

"Why you chivalric fool, as if the way one fell down mattered!"

"When the fall is all there is, it matters."


Borepatch said...

Tim, old privacy habits die hard. But I knew you would have something interesting to say about this. ;-)

Aesop, that was a fabulous movie. And Peter O'Tool was robbed of the Oscar that year. And a bunch of others.

Dan said...

I come here often, and push your writing to twitter often, but this one hurts.
"... "if" you got them back it would not be the person they knew"
Pammy was in ICU only a day and a half before we let her go. It's still hard, 13 months later. We knew she wouldn't want to hang around on machines, and when the doctor confirmed my worries about her ever coming back as we knew her, well, there really wasn't anything else to do but mourn.

Tom Lindsay said...

Like Dan, I come often, and while I frequently talk to the screen, typing all this in is rare.

This past year I lost my brother and my father, both to things we all knew would eventually take them. I can't say whether knowing that ahead of time helped. It's still painful.

On top of that I had a doctor tell me 3 years ago, after some testing, that he had good news and bad news, the good news being that I was still alive, seeing most people with the amount of leukemia cells in their body like I had at the time were not alive. So I knew, like Josey Wales, that I had to get plumb mad dog mean, and fight. So far I'm winning, but I live in condition Red all the time.

I must say, though, that this does give life an enhanced feeling. Naturally I'd prefer it to be otherwise, but you play the hand you are dealt.

We'll talk PTSD some other time. . . .

Divemedic said...

22 years as a paramedic before I retired. I learned that there comes a time when we all welcome death as an old friend. Many of the patients that died in my presence were 60 or more years old, or died because of poor choices.

The ones who still visit me at night?
There are a handful of kids that I always wonder what I could have done differently.
The 45 year old father of two who went from acting strangely, to attacking my crew, to respiratory arrest, to cardiac arrest in less than 10 minutes. It seemed like no matter what we did, he was dying faster than our ability to treat him.
and a few others.

Borepatch said...

Dan, that's tough. I'm so sorry.

Tom, we need to get together again next time I'm in ATL. Keep fighting the good fight.