The Most Important Decision

Have you ever listened to someone trying to explain a complex theory--like nuclear physics or aeronautical engineering--and even though you are trying very hard to focus and pay attention, you really don't understand a damned word of it?  Despite your best efforts to grasp the concepts, you just don't have the education or the background to "get" it. 

I think that is what lay people feel like when a doctor tries explaining their loved one's illness and prognosis.  They are tired, scared and confused.  They don't understand what is going on.  They have a terrible hope mixed with a terrible fear.  And they have been raised on a steady diet of television where all health-related issues can be wrapped up neatly in 60 minutes minus commercials. 

Here's what I think:  Doctors should not be allowed to offer expensive, futile, sadistically cruel options to patients or their families.  The doctor is the educated expert; they need to act like one.  The doctor should have the right and the responsibility to say, "Your mom is going to die.  We will keep her comfortable."

That's it.

Too many families are unable to make a reasonable decision when overwhelmed with all this strange, threatening information (cerebral vascular accident, myocardial infarction, pulmonary embolism, septic shock).  Emotions are coming in tidal waves at such a time.  When offered an option, like, "We could trach her..." scared people are going to leap at that chance.

Isn't a "good" person supposed to fight to have their mother live? 

Do you officially become a BAD person if you agree to let her die?

Will you have to wear a placard?

It is an uninformed decision from a lay person.  Ask an ICU nurse if they would want a trach or a PEG tube.  Ask a cardiologist if they want to be coded.  

Requiring the families to make these types of decisions is unrealistic and unfair.  The doctor is the expert.  The doctor should not offer false hope by prolonging the inevitable.  You don't fix the brakes on a car that has been totalled.

How do we make decisions about other serious matters?  In other areas where people's lives and freedoms are at stake? 

We have a system in place that does just that: it's called the justice system.  This is another area rampant with conflict, emotion, massive expense, human suffering and a strong desire to do the "right" thing. 

So, we bring in twelve people.  They hear both sides of the argument, pro and con.  They weigh the evidence.  Then, they vote.

Does the victim get a vote?  No.

Does the victim's family get a vote?  No.

They can be heard, but they don't get to vote. The victim and the family are too enmeshed to be able to make an objective decision.  Everyone understands that allowing them a vote wouldn't be justice.

Is it a perfect system?   Uhhh--no.

Is it the best anyone has ever come up with?   Absolutely yes!

Nurse's Note:  Anybody out there who has a better idea just come right on up and tell us all what it is.   I--for one--would love to hear it.  

That's how our health care system should handle end of life issues.  It would take the burden off the families and give it to an educated, experienced group of doctors, ethicists and nurses. They could review the case, go over all the data and visit the patient and the family.   Then, they would vote on the best hospital course.


Who do you want making decisions about what should be done to you medically?  This group:

Or this one?

Could they be wrong?  Sure!  Anyone can be wrong.  Juries don't make decisions about people's lives based on evidence that is beyond all doubt.  Juries make decisions about people's lives based on evidence that is beyond REASONABLE DOUBT.  "Beyond all doubt" is too impossible of a standard.

Nurse's Note:  Ignore inflammatory comments about death panels.  We don't call juries, "death panels" even though they are making decisions about human lives.  That kind of provocative rhetoric is calculated to foment fear.

As a matter of fact--ignore anything that ever came out of Sarah Palin's mouth.

People say that I'm judgemental.  It's true; I am.  Everyone is.  And everyone needs to be.

Do I have time to get across the street before that oncoming garbage truck runs me down?  It's a judgement call.

Should I wear my purple socks with this mustard and mint-striped halter top?  It's a judgement call.

Should I go on out on a date with a guy who has both eyelids pierced with rusty six penny nails and a skinned kitten hanging from his rearview mirror?   Judgment is REALLY needed here...

It always strikes me as a silly, specious argument when people say, "Who are you to judge?" 

Who am I?  I'll tell you:  I'm a wife, a mother, a daughter, a sister.  I'm a human being stumbling around on this planet sucking in oxygen.  I'm a taxpayer and a citizen.  I'm also a nurse with plenty of first-hand experience.

Saying, "It's not up to me to judge," is like covering your eyes while your house burns down around you. 

Imagine your dog became too ill to eat or breathe adequately.  If you said, "Oh! I just CAN'T let Fifi die!" and had a trach and a PEG tube put in Fifi and put Fifi in bed where she lay in her own excrement, getting bedsores that ooze pus--your neighbors would call the Humane Society.  

You wouldn't treat a dog that way.

What do we remember?  We remember the beginning and the end.  Writers and directors know this well.  When filming a movie, you want a powerful opening scene to grab the audience's attention.  There can be some slow, saggy parts midway, but the end has to be fireworks-phenomenal.  Because when people think about it later, that's what they'll remember.  The beginning and the end.

Do you remember when you met your spouse?  Most people do.

Do you remember the divorce that ended it?  I'll bet you do.

Don't have the life of someone you love end in a nursing home.   Keep your memories sacred, not polluted by the thought that grandpa died comatose or so demented that he was masturbating to pictures of his grandchildren. 

My family knows never to code me and never to put a trach or a PEG tube in me. 

Ever.

Ever.

If they do, they better HOPE I don't get up from that bed.