May 2, 2011

The Gift of Health

I had two patients in the ICU today, next door to each other. One was a 92 year old woman who was sick, tired, and ready to die. Her body "had just wore out", she told me. Her family was grasping at every tiny diagnosis, not acknowledging the larger picture, that her body was just shutting down. They encouraged her to keep going, to sign a full code status. She wanted a Do Not Resuscitate order.

In the next room, a 92 year-old man was intubated, with shock, hypotension, kidney failure, and a bowel resection for an obstruction following the repair of a hip fracture. His wife knew he had wanted a DNR order, but was feeling guilty about honoring his wishes. She didn't want her husband of 52 years to die, but acknowledged that he had been a vibrant, outgoing person, and wouldn't want to live on a ventilator. She told me that he had never met a stranger, loved to talk and would leave someone new having learned their life story, and she was sure he wouldn't want to live without the ability to speak and give love to those around him. But she still couldn't bring herself to let him die.

As we left those rooms, my attending doctor shrugged and told me "All living things, big or small, eventually die. Why do people not know this?" He was frustrated, having seen many people die and even more live, because of the ability that we have to keep someone alive, which in many cases is more punishing than death.

I've been thinking about health lately. People think that health is a given, it is something they are owed throughout their lifetime. Doctors know better. With the intricacies of the human body, it is incredible that anybody is healthy. And while sad, it is not surprising when people aren't. Nobody is owed health; but it is something many people enjoy and take for granted. Young people, especially, do not know how precarious health is, unless something unusual has happened to them. My parents are beginning to learn, as their friends become sick with cancer or other things that can kill them. My grandmothers know this lesson well, as they survive more and more of their childhood friends.

My mother called me recently, telling me about her own frustrating diagnosis of osteoporosis and many grandmother's debilitating back pain that will preclude her from traveling to watch me graduate from medical school. I was sad, of course. I didn't want either one of them to suffer, and I would miss my grandmother on my graduation day. But, I gently reminded my mom, these things are okay. They are not comfortable, and will need care, but they won't kill you.

I am a regular person, overlayed with the knowledge of a doctor. I look at my family's medical problems through the lens of knowing what can really go wrong. But I also ache for the wife of my patient, because I understand her too. Her husband sounded a lot like my loving, outgoing, talkative husband, and I could see how, after enjoying fifty more years with him, it would be hard to not make a decision out of grief.

It had been a gift to me, as a young person, to deeply and intimately understand the frailty of the human condition. I ride my bike over to the diner with my husband, finishing my lunch in the time it would have taken for my elderly patient to finally get himself into the car. I look at how fast my fingers type, seeing the arthritic nodules of an elderly woman's fingers as she slowly signs her name. It's kind of a sad gift, a wisdom that carries weight along with knowledge. But, I am glad to have received it in my youth, and appreciate it throughout my lifetime.

1 comment:

  1. This is a beautiful post! The beginning reminded me of this Atul Gawande article from the New Yorker titled "Letting Go." It really is sad that too many people take health for granted and they don't recognize that every day, they are making choices that has the power to either positively or negatively impact their health.