Consider this...You are in an accident. You have been left with a pulse. You cannot breath on your own; you never will. A ventilator breathes for you. You cannot eat; you never will. There is a tube in your stomach or through your nose down into your stomach that a "nutritional supplement" will but put into to feed you. Your eyes may open; you focus on nothing; you never will. You move around in the bed some; it is only reflex movement. You have no control over your bladder or bowels. Someone will have to change your diaper. Your brain has been permanently damaged either by the trauma or oxygen deprivation. Because you are now bound to a bed you will develop pressure sores; it is unavoidable even with the BEST caretakers when you are in this condition. Honestly, with this injury (confirmed by ct scans) you will not even know that you are in this condition. You are essentially brain dead. You have no Quality of life....only a pulse.
DO YOU WANT TO LIVE THIS WAY?
Consider this...You have had a long full life but you are nearing the end. You have been unable to care for yourself for quite a few years now and have lived in a nursing home. You no longer know anyone. You wear a diaper. Someone feeds you a baby food like substance. You sleep most of the time. You no longer talk. The last time anyone heard you speak, the dementia and Alzheimer's made your thoughts come out so jumbled that no one understood at all what you were talking about. A few nights ago you aspirated some of that baby food. No one's fault but age. You went into severe respiratory distress and you are now on a ventilator. Your most recent chest x-ray shows that you are now suffering from aspiration pneumonia that given your age and health status you will not recover from. You had little Quality of life before this incident...now you have no Quality of life....only a pulse.
DO YOU WANT TO LIVE THIS WAY?
I could give you scenarios all day long. I do not want to live this way. I do not want to be a burden. I do not want to lay around and be poked and prodded and shifted and turned. I do not want some underpaid nurse aids talking about their weekend or their baby momma drama over me while they wash me. I also do not want my family members to live this way either. If there is no significant chance of having a quality of life, I do not want a pulse!
I see a lot of this in my clinicals. In this weeks clinical rotations, I had 3 patients whose quality of life is gone. They only have a pulse. The families had some tough choices to make.
One of these patients, the family made the choice to terminate life support. That means that my job was to extubate (remove breathing tube in her mouth) and turn the ventilator off. This patient passed away a short time later. It was her time to go home to Jesus. Her family was around her with no crazy tubes in her nose and mouth when she slipped peacefully into eternity.
Another man maybe in his late 40's has MANY health issues, he lays completely unresponsive with no hope of recovery. His eyes are glazed and his pupils fixed and unresponsive. His family does not want to make the decision to "kill" him (their words). They want the doctors to pull out all the stops and treat him as if he will make a miraculous recovery and hop on up out of that bed. They are holding on so tight that they will not even opt for a trach so that he can be ventilated without the tube hanging out of his mouth. They are not bad people. They love him immensely. They just can't let go. I wonder if they stopped to think about what they would want him to do if it was them laying in that bed with that prognosis.
The last patient was an older man riddle with melanoma that has metastasized. The cancer has taken over his body. It is only a matter of time. He can breath on his own and was intubated to make it "easier" to suction the secretions instead of running a tube down his nose into his lungs. It broke my heart to see his wife of many years stand by his bed with one had on his chest and the other clutching a tissue and dabbing her eyes. She loves him. I have no doubt. It will be hard to live without him after many happy years of marriage and even after this long tiring battle with cancer. I could tell that she is aware that the end is drawing near and she was thinking about the decisions that she will soon have to make. Although his quality of life is gone, he does have more than a pulse. But that will cease soon.
When my Grandma passed away it hurt my heart more than you could ever know. BUT I knew it was her time to go home to Jesus, to be reunited with my Granddaddy and Granny and Papa. I did not want her to stay here with me if she could not have a quality of life. No, she was not on a ventilator or anything. But we had a few options to help slightly prolong in a nutritional sense. We knew she would not want that. We brought her home and she passed peacefully at just the moment God intended. My prayers in those last days were for God to either make her better to the point of coming back home to live at momma and daddy house again (I knew that was not going to happen) or just take her home to Heaven. I miss her SOOO much!
I know how hard it is to lose people you love. I have had soooo many people taken from me in my 33 years here on this earth and I know I will continue to lose more and more because that is life. I know how it feels to stand at that bedside and know that you do not want to let go but nothing else can be done and what you see laying lifeless with a weak pulse and a machine breathing for them is all they are ever gonna be. These are not easy decisions to make... NOT AT ALL!
Don't be selfish!! Ask yourself "Does (momma, daddy, aunt...) want to lay here this way?" I'm not saying jump the gun and DNR everyone! I'm saying make an informed decision taking into account the prognosis given by the doctors and what you feel DEEP in your heart that your loved one would have you do. IF your family member has advanced directives ( end of life wishes ) such as being a DNR or an organ donor, not wanting to be intubated or be hooked to a ventilator....PLEASE respect these wishes. I have learned that the family can override all of these things. What gives you the right!?! Why would you not respect your loved ones last wishes?!?
If there ever comes a time that I have no quality of life, only a pulse and a ventilator....LET ME GO!! I know you love me! Please know that I love you too! Please know that it is OK to let go of me! I know my Lord and I am not afraid to die. Please don't be selfish and let me linger here to become a burden and NEVER EVER let releasing me to go home to Jesus burden your heart! Please donate every viable piece of me to help someone else live to their potential! These are my wishes.
I know this is a depressing morbid blog post but it is real life!!
