Thursday, January 15, 2009

what do you say?

i took time to talk to two elderly patients today.

one was a woman who had a cerebrovascular accident a couple of years ago and, as a result, became totally dependent on her children. eventually, her kids could not take care of her and put her in a nursing home. there, she developed large sacral and ischial sores that became badly infected. today, she complained that she had constipation and was in extreme discomfort. as she kept pestering me to help "dig her faeces out", she said, "why do i have to live this way? please, why don't you get some drugs and make me die in my sleep? i would rather die than be like this."

another was a man with uncontrolled diabetes mellitus. the inevitable happened and he ended up with a non-healing ulcer on his foot. his toe was amputated, but because his diabetes control was poor, it eventually became gangrenous and a partial foot amputation was done. the story repeated itself yet again and i when i spoke to him today, he had just undergone a below knee amputation a week ago. he was obviously frustrated with his inability to keep his blood sugars under control and that was when he said to me, "i think it's better to be dead than to suffer all this."

what do you say to that? is there any right way to handle this? do you tell them that no, life is worth living, look at all you've accomplished in your 70 or 80 years of life? Jesus loves you? ever thought about the afterlife? or do you nod your head in agreement and say yeah, you're right, it really is a pitiful way to live, sans lower limb, sans family, and with a huge purulent sore right there at the buttocks?

once, my parents went to the funeral of an old woman who suffered a stroke almost 10 years before she died. she was recumbent for all those 10 years, was in and out of the hospitals for renal failure, infected decubitus ulcers, orthostatic pneumonia...whatever complication of prolonged recumbency there is, you name it, she had it. in the end, she lived to be a nonagenarian...if you could call the last 10 years "living"

when they came home, they told me that if they ever got to a stage like that, they would prefer to end their lives than to live any longer. and then they looked at me for a response.

i gave them exactly what i gave those two patients today...silence. a million approaches, a thousand replies ran through my head and i said none of them. perhaps it was out of fear - of being challenged, ridiculed - that i said nothing. or perhaps it was wisdom, knowing that usually those questions asked are rhetorical and actually don't warrant a reply. not from me, at least.

or maybe i'm only 75% sure of my stand on euthanasia and, as a wise lecturer of mine once said, you should never open your mouth unless you're sure of what you're saying because there's no such thing as a 75% doctor. it's all or nothing.

call it ethics, religion, culture or psychology...what we really need is a clinical practice guideline on how to deal with situations like these.

lishun at 6:07 PM