This past week I was reminded to appreciate life and death equally.
A patient of mine was afraid of dying. Perhaps we all are. To some extent and in some instances that is a healthy fear to have! But there was something different about it this time: this developed after an attempted overdose. The snowball rolling effect of what followed reminded me of one of Paulo Coelho’s books – Veronika decides to die. While never hiding the actual truth, some healthcare providers allowed an ever so slight hint to an inexorable that could happen afterward. It wasn’t a lie, but rather a treatment lesson. Sometimes, when in our fully trained and experienced judgment the patient’s belief seems driven by an altered decision-making-ability, then you do what you have to do clinically and ethically. In the book, the doctor lies to Veronika telling her that she is about to die soon and – as a reader – you reach the mindfulness to fully understand and support that. This freed Veronika and helped her become who she actually was: a wonderful human being. While triggering this memory, my patient did not fit the same model, nor results. Unlike Veronika, this patient lacked proper supervision and guidance. It was now long after the overdose attempt and I was the one entrusted to answer a simple drug-related question: how much harm did I cause myself? There was a short answer and a long answer to this. The short answer was “None”, but for many reasons, I thought that an unfortunate set of circumstances could easily turn this short answer into the wrong answer. So, I decided to go the long way instead and I didn’t feel ready for it. I had to prepare. No, not my answer, but its actual meaning and implications. I couldn’t write. I had to think, I had to think very carefully…
Before the week was over, one of my friends was stumbling at the realization that life was much beyond breathing in and out. Life meant being there, giving and receiving… Watching the most important human being on Earth for you on artificial life support for nearly a year raises questions that are impossible to answer… To quote one of my preceptors: “life is all about quality”. What do we know about the inner world of the unfelt touch, unspoken words and unperceived vibrations? By all the means and rationales of clinical practice, successfully transitioning a patient on life support is a fantastic achievement! The patient is alive. The patient would be dead without it, no doubt. Is this still a fantastic achievement one year later without enjoying a smile, a walk, or sunlight? For science, yes, but for the patient… we don’t know.
Encountering these stories during the same week was a very harsh contrast. I found myself counting my own reasons to live and asking myself what should I tell my loved ones to help them understand when they should let me go if the unfortunate ever strikes. The present brought to my mind two memories that stayed with me for decades now. The first is the memory of the time when I learned that my Ph.D. advisor’s life support was disconnected. I was miles away, in the middle of the night at the Max-Plank Institute in Dortmund, reading emails while waiting for my E. coli culture to grow. The extent of pain and frustration that flooded my senses when I learned about what happened was beyond belief… That man meant so much to me!! I locked myself in the cold room for a long while trying to literally communicate to my own mind and body to cool down. It was bad, very bad… It took me a long time to understand and accept that withdrawing life support was the right decision. Back at the time, I did not have the clinical training I have now, although I was decently educated. I absolutely had no business to have an opinion. But, should I have been asked what I thought that was the right or wrong thing to do, I would have picked the wrong because I was afraid to face the truth: that he was dead already.
The other memory I have is from the time I was an aspiring clinical pharmacist shadowing palliative care services. There was nothing exciting about shadowing palliative care. Not even interesting. It was just heartbreaking. But one day my thoughts changed. The hospital admitted a 90+ years old very frail lady who was transferred from a nursing home facility to be evaluated for and transitioned on life support. She stopped eating, drinking, talking, moving, or opening her eyes. Not having any family or healthcare proxy made any decision taking twice more difficult than it would have been otherwise. Her heart rate was normal, pulse was normal, all looked otherwise very normal. She didn’t have any health condition and was in no apparent pain. We initiated hydration and were in progress of deciding whether or not the placement of a tube for feeding was appropriate, although the lack of any family member in charge to take this decision was a very serious problem. If a tube placement was decided, pharmacy (i.e. myself at that moment and place) would have been next consulted to evaluate nutrition needs and recommend the appropriate formula for support. Having read her medical chart, I was very unclear as to what help could palliative care provide regarding the tube placement decision and how our visit could make any change to the course of this patient’s care. Yet, I knew that I was there to rather learn than change, and I was grateful to God that I wasn’t alone. My preceptor entered quietly, looked at the old lady and reached her left side of the bed slowly enough to barely move the air around her. She arranged her hair, pulled the blanket all around her and gently touched her arm leaning forward to her ear. “God is waiting for you, don’t be afraid, let go…”, she whispered. The old lady smiled and then seemed deeply asleep. She became an angel soon after leaving behind an unexplained but profound sense of happiness.
Both my present and past collided into the understanding of so many deep meanings this past week. This made me think that we are meant to come into this world only when we are fully prepared to leave the womb. Then for the following many decades all that we do is strive to survive longer, somehow working to achieve a similar preparedness for leaving an even bigger womb this time to ascend (or escape?) into an even bigger world that will prepare us further to later approach our existential purpose. Like a rough awakening, when I thought that I sort of got closer to understanding more, Las Vegas mass shooting happened – almost like a warning sign that I shouldn’t fool myself believing that I made sense of anything. It was a rough, very rough week, but I was thankful and humbled for being able to count myself among the lucky ones…
That’s my brief update for today. I’ll be back in touch soon to share more about anemia – stay healthy!
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