Many of us imagine dying surrounded by loved ones in a peaceful last chapter to a life well-lived. We would all like to leave this earth without pain or suffering. Unfortunately, this is not how most of our stories will play out.
In my work, I am not a stranger to many families worst days. I meet them while their loved ones gasp for air or scream in pain. Some are unexpectedly found unconscious and unable to speak. In the vast majority of these situations, the families are faced with the impossible task of deciding what their loved one would want in the last days.
Would she want to be connected to a breathing machine? Would he want chest compressions performed during CPR in an attempt to restart his heart, even if it meant broken ribs? These questions are difficult for people to answer, even in the calmest situations. These questions are nearly impossible and potentially unethical to answer while in the stressful and emotional setting of a loved ones critical illness.
I recently told a patient she would die within the next few weeks. I explained how her remaining days would likely go. Our team had discovered she had a rapidly progressing neurological disease that would take away her drive to breathe. She was awake and able to comprehend the weight of our conversation.
Five days prior to this piece of information, she was critically ill. This patient did not have an advance directive detailing her wishes for how she was to be treated should she become severely sick. She was, by default, subject to the full might of our medical interventions. Tubes were placed in her nose, neck, groin, bladder and veins.
If she had arrived at the hospital an hour later, a tube would have been inserted into her lungs to help her breathe. At this point, she would have been given medicines to make her sleep. With a breathing tube and her underlying medical problem, she likely would have never been able to tolerate breathing on her own a gain.
My patient improved, and faced with certain death in the coming weeks, she courageously chose how she wanted to live her last days. She wanted to pass with dignity, surrounded by family, without pain or suffering. She wanted to do it her way at home without confusion or anxiety for her family members.
I have mixed feelings when I think through my experience with her case. Would I have wanted to know my diagnosis? What would I have wanted doctors to do if it were my mother or sister or wife lying in the emergency department that night? According to nationwide surveys, only about 25 percent of people have living wills detailing their wishes.
What I have concluded from her case is that there are no right answers when it comes to end-of-life care and decisions. What does matter is having these conversations with family and, if possible, documenting them in an official way so they can guide your care when difficult decisions have to be made.
Leaving to home hospice care, she asked, So Im on the road outta here?
Yes, maam, I think we all are.
Cameron Lambert. M.D., is a Knightdale native completing his internal medicine training at Emory University in Atlanta.