Monday, December 6, 2010

Giving a Shout Out to Death

So I'm rotating through Neurology. Back on a "real" medicine service. Back to the ED and NSICU. Back to ventilators and monitors and tubes of all sorts sticking into various orifices, both naturally occurring and man made. I am definitely out of my element. I have loads of respect for the docs and the nurses who can run this show but it's not my bag. But whenever I'm around the whole "life/death" scene, it gets the wheels to turning....

So yesterday morning, my team goes down neurosurgical intensive care unit to see a couple of folks. (BTW, I know more about bullfighting than I do neurosurgery but anyway...) First we saw a 23 year male one week out from a gunshot wound to the head. He's basically brain dead on a vent. Then we saw an 85 year woman, chronic alcoholic, in and out of status epilepticus since the evacuation of her subdural hematoma a few days earlier. (On 4 antiepileptic drugs and still seizing away). Then the stroke pager goes off- a 70 something year old guy comes in from who knows where. Last seen normal 2 DAYS earlier. He had stroked out but was way out of the intervention window so we didn't contribute much. But I did watch the ED staff spring into action and start applying the full court press. Which is great. God bless them. Seriously. People who know what to do in those situations impress the hell out of me.

There are many, many examples of how western medicine mitigates unnecessary suffering. If a six year old has a brain tumor and surgeons can fix it, go for it. If folks in their 50s and 60s can have their cholesterol reduced and blood pressure controlled by taking a few pills- have at it. I'm sure I’ll be on some of those pills myself one day. But I'm looking at this old man who is completely out of it, dried vomit down the side of his cheek and all I can think is "What in the hell are they doing?" This guy is doing his very best to die and these folks are getting in his way.

So I spend the rest of the yesterday and much of today thinking about life and death and heavy stuff like that : ) I was thinking about how our society, generally speaking, hails birth as a 'miracle' while it gives death the shaft. Now I''m not saying that birth ISN'T a miracle. Obviously it is. The arrival of a a brand new, never been here before human being is mind blowing stuff- completely unfathomable. So I'm not talking about that. But what about the other end of the spectrum. Why does death always get such a bad rap?

Just look at the symbolism we use for each. Birth is represented by the friendly, reliable stork, dutifully traveling to your town to drop off another "bundle of joy." Death is represented by the Grim Reaper- the ultimate party crasher and most unwanted of bedside guests. My point is that this all seems a little lopsided. I mean, considering that you can't have one without the other, considering that every other living thing on the planet goes through the same process, considering that buying the farm is completely inevitable and obviously the way things are supposed to be, I'm just wondering why we can't invite death in a bit more.

It’s obviously perfectly OK to be wildly and utterly inconsolable over someone's passing (not that you needed my permission). There are plenty of people whom seeing in an ICU bed would leave me devastated. But at the same time, when I was looking at that old fella in the ED, part of me just wished things could, at least some of the time, be different. The following may sound like polyanna-ish you-know-what but of course I've never let that stop me before…

What would it be like if we weren’t conditioned so deeply to be afraid of death? What if death just seemed natural, not like an “ending” but rather a different facet of existence, as equally as unfathomable as the “life” part? What if, as part of their training, health care workers were taught to apply not only their medical know-how but also their intuition to the cases that came into the ED? What if, as a society, we were accepting of certain individuals “making the call" in emergent situations? What if these individuals were trained to rapidly assess not just medical parameters but also factors such as age and quality of life? What if these individuals did not have to be concerned with law suits as society in general trusted that they would make the best decisions possible? And what if, when the situation warranted it, these individuals could say , “OK, everyone- stop what you’re doing. It’s time. Let’s start getting Mr Johnson ready.”

And what if, just like that, the rushing around came to a halt. What if everyone present took a deep breath, looked at each other and smiled, knowing that they would, once again, have the privilege of helping someone die.

What if someone dimmed the lights while others removed the leads and withdrew the tubes. What if one person washed his body while someone else played with his hair. What if one persons only job was to bundle him up in warm blankets and soft pillows. What if those in attendance were fear-less as they did all of this, knowing that what they were witnessing was just part of It All, nothing less than the majesty and mystery of life returning back from whence it came. What if they had no conditioned fears about dying such that “seizures” and “agonal breathing” were not seen as conditions to “treat” but rather as the rhythmic motions of the body’s last dance, as perfect an unfolding as the birthing occurring simultaneously on another floor. What if someone pulled a chair close and began to whisper softly into his ear “Mr Johnson- it’s safe. You're not alone. You’re with friends. You’re with people who love you. It’s safe to let go. You’ve lived a beautiful life. It’s safe to let go.”

And what if he did? What if this type of work provided him with that last needed bit of strength, allowing him to finally let go into his own beautiful destruction, another perfect wave returning to its Source, the illusion of separateness marveled at for just a moment before vanishing back into the "Ocean of Infinity."

Just wondering.

JCO MD 02/09