Thursday, February 12, 2009

Lucky To Be Alive??

Lucky to be alive....I hear that term a lot. Sometimes its from the patients themselves when they overcome something great....and it's a good thing. But a lot of the time I feel really bad for people who are "lucky to be alive."

A few months ago on trauma a 23 year old was brought in by EMS after an electrical injury. The man was working near power lines and accidentally hit his head against a wire. He basically shocked his brain and literally blew off his face. It was one of the most horrible things I have ever seen. No bleeding, just a huge crater of a face. His cheeks, facial bones, nose, eyes, forehead....everything was gone up to his cranial vault. The rest of his burns or areas missing. His spinal cord was shocked too. We intubated him, resucitated him, and sent him to the ICU. I was for sure he was going to die. So was his family as they rushed into the er and lost their stomach contents as they saw their husband/son/brother lie there helpless and unrecognizable.

4 months later I started my Burn ICU rotation. Very sad floor. People with life altering, disfiguring, and disabling burns. My first patient was a man who was breathing by a trach (tube in the neck hooked up to a machine to help him breath). He had towels over his head. As I examined him, I removed the towels and discovered it was HIM. He was still alive. One side of his face had been covered up with a muscle from his back to close the area. Just covered...not shaped to a form of a face. He can't have a face transplant b/c he has no nerves. It was worse than I remembered. This time there were pictures of him and his family and kids all over the room. I try not to look at that. All I can do when I see him everyday is pray for him...and pray that he somehow has some kind of peace. His spinal cord.....still shocked. Can move his finger tips and toes...thats about it. And the worst part...he is completely cognitive. He can hear and understand everything.....and is helpless. I can't imagine being in that situation. Lying there without being able to move and without a face and eyes. Knowing you will never have one. Thinking about my quality of life and what my kids and family are going through. Is this guy really lucky to be alive??

There are so many cases like this. People burned from head to toe, nursing home patients who we refuse to let die, end stage cancers that have failed every treatment and trial getting sicker and sicker, etc. It costs millions medically, and that doesn't factor in the psychological burden on everyone involved.

Are we playing God by keeping people around to suffer? I don't get the purpose, but I also don't see how to change it in our society. Hospice and/or "letting someone go" has gotten a bad rap. It is not "PC" enough I guess. I am supposed to be a patient advocate, but a lot of the time I don't think I am able to advocate for what I feel is best.

ER doc


Anonymous said...

I hate to bring this up on such an old post ... but did anyone ask him, whether he wanted to live or die?

Anonymous said...

Today we have cochlear implants.
In the future couldn't we have electronic eyes and ears implanted?

Nurse Carolyn said...

I see it a lot... I took a NG tube out of a lady after an acute CVA and several failed attempts at rehab...she passed 4 days later.

Her Advance Directives were VERY CLEAR that this was what she wanted and she was very capable to communicate yes/no answers by shaking her head. I was at peace with it. She died being made comfortable with her family at her side.

Sad part was after no respirations or heart rate for one full minute, her husband with dementia, said to me.. "she is ok?" ..I had to tell him no, she has passed. He could not comprehend the loss.

Folks, make your wishes known, even at a young age, it's the power of the pen to speak for you when you can not. California has forms FREE on the web that you do not need a notary to sign.

Liz said...

I'm a hospice RN, my hospital background is oncology.

My experience with patient's wishes are that even hospice patients (and especially their families) who "know" the score, really don't. Dying is a process.

Finally, once a patient finally realizes that to live is to live like THIS; weak, helpless, bedbound, ill...when they finally understand that health is not goint to return.....then and only then can the patient "let go". A peaceful death is then possible.

The point is: people who realize that their physical quality of life is in the toilet nearly always choose to go. (A few, usually highly controlling people, are never let go....death is usually not peaceful for these).

Homeless Parrot said...

that's why i'm glad i'm an animal doctor and not a human one. we do amazing things for animals - chemotherapy, radiation, complicated orthopedic repair. but we can also stop and help our patients die with dignity. that's a gift we can give too.

DreamingTree said...

That has to be a living hell for that man. So very sad...

Doc J said...

During my time in the ICU with John Doe: He had seen is brother receive the ‘blue plate’ special of ACLS (and died). He had seen this and decided (about 12 years ago) he wanted nothing to do with this and had a living will that stated as much. He also knew he had bad single vessel disease at the time. Fast-forward 12 years, and three hernia operations, latter. Now he threw the big one, having diffuse and near-occlusive three vessel disease. His new wife countermanded his order and said we gotta do everything we can. After a couple of weeks of circling the drain he finally passed. Receiving the ‘blue plate’ special—just like he didn’t want. I called my parents and made sure they understood just what a living will was and what things they wanted me to enforce (i.e. don’t keep me alive if I am going to be a turnip).

Anonymous said...

This story is sad. Living Wills are SO important. I am a 25 yr old RN and have had one since I got my license 4 years ago. Sometimes all the "miracles" we have in medicine just aren't appropriate.