End of Life Thoughts
I’m not quite sure of what I want to say here, but I felt like something should be written, so here I am. I am unable to think of an appropriate word that conveys what I feel when I tell one of my patients they are expected to die. I think the word that probably comes closest in my mind, right now, is hurt. It hurts me to do this. It makes my heart hurt. I have struggled/am struggling through emotionally tough times within my own family, but there’s something different when you share a moment that intimate with someone you hardly know. The pain is different, but still very real. Prior to ever having done this, I thought it would be easier, since they were strangers…I could kind of emotionally disconnect myself from the situation. Well, it’s not easier, and I’m not able to emotionally disconnect any part of me from the situation.
CS is a 70 y/o man who was admitted about 3 weeks ago for shortness of breath that had itself been increasing for a couple of weeks previous to that. We were consulted for a bronchoscopy / biopsy of a lesion discovered on CT scan. The biopsy came back adenocarcinoma of the lung, with a tumor that was mostly obstructing one of the apical bronchioles in the left lung. Of the people who have this type of cancer, 99% are smokers….well, CS has never smoked in his entire life. He had always been around smokers, though. This was a new diagnosis, so we went to tell him that he had lung cancer, that it was partially obstructing, and that if he was agreeable, he needed to start chemo/radiation. Over the past couple of weeks since the diagnosis (he’s been in the hospital the entire time), his oxygen requirements have progressively increased, without expected increases in his pO2, the amount of oxygen actually in the blood. CS was transferred to the ICU, and we were again asked to perform a bronchoscopy because mucous plugging was the suspected culprit that had caused this rather acute decline in respiratory status, even since admission. Because of his increased oxygen requirements, we needed to intubate CS in order to safely perform the bronchoscopy. After much thought and what must have been difficult contemplation on his part, CS agreed, with the understanding that after the procedure we had 72hrs to get him off the ventilator and the breathing tube out of him. He didn’t want to be on a ventilator, and after 72hrs, he wants us to extubate him and just make him comfortable until he dies, which appears imminent, considering how much oxygen he’s requiring. Well, 72hrs is around lunchtime Wednesday, 03/22/06. I went to see CS this morning, to try to figure out why he’s still needing so much oxygen, and what makes it even more difficult is that he’s awake. He’s just laying there in bed with his eyes open, tracking me, watching me, and listening to me. He shakes his head, when appropriate; he’s “all there,” but just has a breathing tube in his throat, and we can’t safely remove it. It was cold and rainy outside. I could hear the soft pitter patter of the rain on the window. It was dim in the room, since I hadn’t turned on the light. I remember there was a lot of silence; it surprised me how quiet it was, despite being in the ICU; maybe it just felt that way. I normally like to talk, but not this morning. I didn’t feel comfortable saying anything. My heart hurt for this man. He made hand signals to me and mouthed that we had one day remaining, then he wanted the tube out. He knows what he’s asking…he knows he will likely not survive long after the extubation. I asked him if he knew the Lord, and he shook his head yes. I tried to encourage him the best I could with Scripture, challenging him to “rejoice in hope, be patient in tribulation, be constant in prayer [Romans 12:12].” It’s so different, or at least it feels that way, when you’re there, actually having to cling to Scripture because that’s all you have in the situation. How many times have I read Scripture in a manner so far below the faith it demands of me? This man needed the promises of the Lord to be true, and I needed them to be true for him. I asked him if I could pray for him. CS shook his head, “yes.” I leaned over his bed, and prayed as honestly and as humbly as I was able for him, though I’m sure my words must have sounded contrite. I was struggling not to cry too much, and I kept it to a few tears here and there. At least I wasn’t dripping tears and boogers all over this man. At the end of the prayer, CS could see that I was tearing a bit, and he lifted his hand up to my face, patted me a couple of times on the cheek and mouthed the words, “thank you” around the breathing tube. I didn’t want to leave. I just stayed leaning over his bed, in silence, looking out the window and listening to the rain. I am learning a lot about faith, humanity, and the Lord, through medicine; I am not worthy to be where I am, but I am thankful for the opportunity to try to encourage & comfort patients and their families the best that I’m able, given my emotional weakness.
CS is a 70 y/o man who was admitted about 3 weeks ago for shortness of breath that had itself been increasing for a couple of weeks previous to that. We were consulted for a bronchoscopy / biopsy of a lesion discovered on CT scan. The biopsy came back adenocarcinoma of the lung, with a tumor that was mostly obstructing one of the apical bronchioles in the left lung. Of the people who have this type of cancer, 99% are smokers….well, CS has never smoked in his entire life. He had always been around smokers, though. This was a new diagnosis, so we went to tell him that he had lung cancer, that it was partially obstructing, and that if he was agreeable, he needed to start chemo/radiation. Over the past couple of weeks since the diagnosis (he’s been in the hospital the entire time), his oxygen requirements have progressively increased, without expected increases in his pO2, the amount of oxygen actually in the blood. CS was transferred to the ICU, and we were again asked to perform a bronchoscopy because mucous plugging was the suspected culprit that had caused this rather acute decline in respiratory status, even since admission. Because of his increased oxygen requirements, we needed to intubate CS in order to safely perform the bronchoscopy. After much thought and what must have been difficult contemplation on his part, CS agreed, with the understanding that after the procedure we had 72hrs to get him off the ventilator and the breathing tube out of him. He didn’t want to be on a ventilator, and after 72hrs, he wants us to extubate him and just make him comfortable until he dies, which appears imminent, considering how much oxygen he’s requiring. Well, 72hrs is around lunchtime Wednesday, 03/22/06. I went to see CS this morning, to try to figure out why he’s still needing so much oxygen, and what makes it even more difficult is that he’s awake. He’s just laying there in bed with his eyes open, tracking me, watching me, and listening to me. He shakes his head, when appropriate; he’s “all there,” but just has a breathing tube in his throat, and we can’t safely remove it. It was cold and rainy outside. I could hear the soft pitter patter of the rain on the window. It was dim in the room, since I hadn’t turned on the light. I remember there was a lot of silence; it surprised me how quiet it was, despite being in the ICU; maybe it just felt that way. I normally like to talk, but not this morning. I didn’t feel comfortable saying anything. My heart hurt for this man. He made hand signals to me and mouthed that we had one day remaining, then he wanted the tube out. He knows what he’s asking…he knows he will likely not survive long after the extubation. I asked him if he knew the Lord, and he shook his head yes. I tried to encourage him the best I could with Scripture, challenging him to “rejoice in hope, be patient in tribulation, be constant in prayer [Romans 12:12].” It’s so different, or at least it feels that way, when you’re there, actually having to cling to Scripture because that’s all you have in the situation. How many times have I read Scripture in a manner so far below the faith it demands of me? This man needed the promises of the Lord to be true, and I needed them to be true for him. I asked him if I could pray for him. CS shook his head, “yes.” I leaned over his bed, and prayed as honestly and as humbly as I was able for him, though I’m sure my words must have sounded contrite. I was struggling not to cry too much, and I kept it to a few tears here and there. At least I wasn’t dripping tears and boogers all over this man. At the end of the prayer, CS could see that I was tearing a bit, and he lifted his hand up to my face, patted me a couple of times on the cheek and mouthed the words, “thank you” around the breathing tube. I didn’t want to leave. I just stayed leaning over his bed, in silence, looking out the window and listening to the rain. I am learning a lot about faith, humanity, and the Lord, through medicine; I am not worthy to be where I am, but I am thankful for the opportunity to try to encourage & comfort patients and their families the best that I’m able, given my emotional weakness.
posted by Frank Bob at 7:28 PM
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