I recently had the chance to read Atul Gawande’s most recent article “Letting Go” published in the July 26th edition of The New Yorker. In it he attempts to answer the question “what should medicine do when it can’t save your life?” The article chronicles the end of several terminally ill patient’s lives and the unwillingness for modern medicine to let people die at home surrounded by loved ones rather than chained to hospital beds by invasive tubes, ventilators, and health care professionals. He examines the true nature of hospice as a beacon of shinning hope that allows patients to be home to the end and extends the quality, not quantity of life.
As young American in my mid-twenties it is difficult to imagine dying. Sure, I’ve been sick and my mother might even relate to you the countless sleepless nights she spent worrying over my health when I had that season’s flu or the especially awful case of mono I endured during my senior year of high school. But I have never really, truly been close to dying. I don’t know what it feels like to be told you have cancer and that you only have months to live. I haven’t lived long enough to see my friends wither slowly in a nursing home and I’ve been fortunate that my grandparents have been able to avoid that fate thus far. My grandpa died quickly of a series of strokes and my grandmother passed later after a long battle with cancer that she lost in the home of her eldest son under the care of hospice. But even at my young and healthy age, the “medicalization” of death scares me.
Don’t get me wrong. I’m all for scientific advancements in the field of medicine. I have a love of research dating back to the “experiments” I conducted as a kindergarten on my pet worms. The love carried me through a slew of AP science classes in high school and through the successful completion of a Neurscience BS in college. After college, while my classmate chased the call of medicine, I chose research and became the clinical research coordinator. I even said in the interview for my first job that "I don't really care how I'm involved in research, just that I am involved in research that will help make a difference in people's lives." Shortly after that, I started my Bioethics program and my eyes were both metaphorically and literally opened.
I have stood by the bedside of the critically ill and listened as the hospital’s ethicist attempted to mediate between patients who are ready to go and doctors who aren't ready to let them. I have heard the reluctance of family members to let their loved ones “give up” and choose options that would shorten their life, but ease their suffering. I have read news articles about those who commit suicide rather than let their medical condition cause them to lose themselves or suffer immeasurable pain. I have studied the “right to die” movement. Throughout it all, I have sensed the desperation felt by parties on all sides of the equations. The doctors, unwilling to “fail” a patient by “letting them die,” continue to push treatments that often cause more harm than good. The patients, who don’t really know any better because they have never been told they have a choice, blindly following until they are but a shell of their former selves.
I spend each day working hard at an educational medical facility attempting to ensure that scientific research improves medicine so that it can not only extend our lives, but extend the quality of our lives as well. But, I hope when it's my turn to go I will do so with dignity. I don't want to spend my final days on this Earth stuck in some sterile ICU and I don't want to blindly try treatment after treatment just to buy a few extra days, weeks, months, whatever. When it's my time, I hope I go quickly with my mind intact. I hope to keep living life until there is no more life left to live.
And I hope that by posting this somewhat disturbing (and hopefully thought-provoking) post, you will also consider how you would like to leave this world and what role medicine will have in your final days. Please, I implore you, tell your loved ones what kind of medical interventions you want. Tell them how far you are willing to go to stave off death. Name your power of attorney and make your advance directive. Decide now while you are still in control. Update it often as you have time to think about the impacts of your decisions. Involve your family, close friends, and Heavenly Father. Talk about dying now before you are actively doing it. Though difficult, I truly believe that talking about these issue now will help save your loved ones grief in the future.
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