Saturday, October 4, 2014

When enough is enough

During most of human history, an individual's life had a natural progression.  One was born, they lived, and they died.
Advances in the past hundred years or so have complicated this.  So much that can be done to extend life, and advances have developed so quickly, that mankind struggles with how to answer the question,
"When is enough, enough?"

Surely we still have situations where a patient arrives with a cardiac arrest either through a massive heart attack or trauma that have left them pulse-less for an extended period of time, despite CPR, emergency medications and sometimes even defibrillation.
There is generalized acceptance that 20-30 minutes of purse-less activity, in spite of these heroic efforts, is reason to stop.  Despite the age or previous health status of the patient, nothing further can be done.
"Dead is dead."

But increasingly, situations occur where it is not so clear.  We can do so much to extend life that we find ourselves having to make decisions about how far we should go, and more often than not, these decisions cannot be made by the patient, they fall on the families.
These are hard decisions, and each case if unique.  There is no algorithm, no one set answer, to guide us.
The age of the patient, the general health status prior to the event, the patient's previously expressed wishes, the religious and cultural beliefs of the patient and family all play a role in the decisions.
A good Chaplin can help a family come to a decision that they are more or less comfortable with, but always there will be doubts, there will be questions.
"Did we do the right thing?"
"Did we do what mom would have wanted?"
"Did we do enough?"

The healthcare provider is not a bystander in all of this.  Many times we have been asked, "What would you do?"
School did not prepare us to play God, and sometimes that is what it feels like we are being asked to do.
I fall back on my beliefs, that there is a time to say enough, especially if the baseline quality of life is poor or if the patient's life is filled with pain, but in the end, I usually revert back to this question, "What would your mom or dad want?"
They usually know the answer.

Many healthcare professionals know this scenario from both sides, as we have also been the families, having to make the decisions.

Having experienced both sides I can say this for certain, you will have doubts, you will wonder if you made the right decision, you will wonder if you gave the family the right answer to the question, but in that moment, whether you are the healthcare provider or the son or daughter, you will become a part of the same family.
The families whom I have cared for in this difficult time have become a part of me.
The doctors and nurses and techs who were there for my mom will always have a place in my heart.

Sometimes when we can do no more, is when we do the most.

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