Tuesday, August 5, 2014

The Greatest Act Of Courage

The patient had had enough. His body was trying to die and he knew it. Every organ in his body was whimpering for relief but the doctors would not allow the inevitable. He had suffered cardiac arrest a few times but well-meaning medical professionals were always able to bring him back from the brink.

He and his family knew that the doctors and nurses were just doing their jobs. He had an entire army of specialists to look after every organ system that could possibly wrong. But did they have his best interests in mind when they sought more and more interventions? Every organ that was failing had a mechanical means of repair. But is that the same as living?

When his heart stopped and was brought back again, the cardiologist promised he could implant a shiny metallic device, a marvel of modern medical technology, to keep it going, even if it just wanted to conclude its inevitable path. When his lungs got tired of exchanging air, the pulmonologist assured him a few days of mechanical ventilation to rest his alveoli will make him breathe easier. When his kidneys could no longer perform their filtration functions, the nephrologist wanted to hook his brittle veins up to a large machine to get him over his "acute on chronic kidney disease." His infections were expeditiously treated by ID with powerful drugs. His DVT's were taken care of with a mechanical filter and poisons that thinned his blood to the point his skin was covered in large purple blotches. When he got so weak that he couldn't eat anymore, the gastroenterologist promised to relieve his frailty with a tube punctured through his abdominal wall.

The only thing that was still as sharp as it was twenty years ago was his mind. Through all of these traumas, he maintained his sense of humor and devotion to his family. He wanted to be around for them so that he wouldn't see them worry. But now he could sense that more treatments did not make them feel better. To have to see them look at him with such concern every day he was in the hospital caused him tremendous sorrow. And truth be told, he was tired. Tired of the daily needle sticks to get more blood even though they had to transfuse him every few days for anemia. He was exhausted from the alarms that were constantly echoing through the hospital hallways. He missed his own bed, the familiarity of his own house. He wanted to go outside and breathe fresh air instead of the stench of the plastic mask secured too tightly to his face. At last realized that was never going to happen again as long as he lived.

Then the day came when he knew what he wanted to do. He told his family that he just wanted to go. No more tests. No more operations. It was time. The family was saddened but they too realized the truth. They asked for his doctor and told them their wishes. The doctor was astonished that anyone would make such a request. Is he mad? Had he been given any drugs that might be causing altered mental status? No, the patient said. He had made up his mind. Nevertheless, the doctor performed a complete neurologic exam to document that indeed the patient was "A and O x 3". After making a few phone calls to let the patient's legion of physicians know about this fateful plan, the patient finally got his wish.

He was placed on comfort care only. The letters DNR were affixed to the front of his chart. He had his oxygen mask removed per his request. The family gathered around as he gently rested on his terminal bed. The doctor promised that he could ask for pain medication if he needed them. But he never did. He was finally in control of his own self again. And that was the greatest comfort of all.

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