Confessions of an Intern

Week Nineteen

This week was exhausting. Do you hear a common theme? Exhaustion...freaking tired...sleepy. Anyway, this week took its toll on me for reasons besides physical fatigue. It seems I have become a hospice magnet. Half of my patients have been discharged on hospice care so far this month. I kind of worry that I've gotten a reputation, but as I think on it, it's not that my patients have been dying, but really that I've helped arrange a more peaceful, dignified passing for them. All of them has had an incurable, terminal illness. I did not give them the cancer they were dying from, or the end stage lung disease. But I did offer the opportunity for them to have a say in how they die.

I've been talking a lot to families, obviously. It is always easier to think about your wishes or what your loved ones' would want when they aren't critically ill, or too sick to speak for themselves. I would encourage all of you reading to think about what you would want for your last days, or what your loved ones have told you about their wishes. Now, my dad told me if he had a terminal illness he would take care of it himself with a 12 guage shot gun. I would not be okay with that. But I also would not be selfish and keep him here longer than his body could handle. I am not a proponent of assisted suicide, and I don't want to open that can of worms. But...I am a proponent for people dying with dignity, not having their ribs crushed, their bodies artificially kept alive, rotting the whole time, just because some one can't let go. With all of the medical advancements out there, it is possible to keep almost anyone alive, at least for a little while.

CPR-chest compressions...if you do it right, you've broken some ribs. Not only does that hurt, it can do damage. The argument is if we don't do it, they're dead anyway. I've thought about my wishes. They are different depending on when my life is in danger. If I am young and my kids are still growing, I want to be resuscitated if possible. I'd even consent to being kept on a ventilator or tube feeds for up to six months if there is a hope (a real hope) for meaningful recovery. Meaningful meaning that I can talk and interact and know my family. That I can take care of myself for the most part. I have been closer to death than I wanted to be a couple years ago, when I had a bad infection after surgery. I have been so sick I wished I was dead rather than go through what I was going through in that moment. Needless to say, I praise God that I am alive and well, and for the most part better than ever.

Weekly challenge: talk to your family about your wishes and what they want. Make a state approved advanced directive and/or living will.