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Stuart Revercomb

Stuart Revercomb is a marketing consultant and joyously married father of four children. He seems to remember someone once telling him he ought to be a writer. "The Unseen Here and Now" -- Thursdays.

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August 23, 2001

How Do You Wish To Die?

Having had several weeks to contemplate the loss of our beloved dog Abbey, we have come to the conclusion that after all is said and done, the ol' Ab Dog really did have the perfect life. And part of what made her life so perfect was her "perfect death." In lieu of suffering for several weeks or months or even years, Abbey was blessed to lay down among her loved ones and pass peacefully within the hour.

That we all might be so lucky.

But "perfect death?' It rings a little strange doesn't it. Death is something that for all our faith, if we have it, still does not carry with it any sense of the possibility of perfection. But there are a great many ways to pass from this world to the other, or to "no longer" depending on your view, and if we don't plan for certain contingencies, we have a very good chance of suffering in ways we could never imagine. A Nurse friend of mine recently conveyed the following account of how a fellow nurse passed away. I have changed their names to protect their privacy.

"Sue's" friend "Courtney" was a fellow nurse suffering from adult respiratory distress syndrome as a result of pneumonia. Courtney's sister Laura was her only apparent relative and as the weeks turned to months and her condition worsened the nurses and attendants at the hospital became her extended family. Courtney was glad to know that she could express her wishes to the very people that would be caring for her and loved her most.

But things didn't go as planned. As Courtney's health began to seriously falter, a family member that had been out of touch for years arrived on the scene. He told Laura that he knew what was best for their sister, and that she shouldn't interfere or he would have her declared incompetent due to her recent bouts with depression.

The strategy worked and the brothers wishes were followed. He insisted on maintaining full life support efforts even though the doctors advised him that Courtney had reached a point at which her chance of recovery was, "less than zero." Instead of a peaceful passing in accordance with her wishes and befitting a life in which so much was given to so many, Courtney died an excruciating death. The following two messages sum up the situation my friend and Courtney's "extended family" faced :

Courtney is now the victim of another disease - a disease that often allows the law to override the wishes expressed by a patient. This disease happens way too often. Even in the case of a "living will", family members frequently come in after the patient is in crisis or unresponsive and ask for "everything possible to be done. Doctors are often placed in difficult situations, - rightfully fearing legal action from the living family members if they follow the noninterventional wishes of the patient. This often leads to the final days of life being spent with massive fluid resuscitation, painful ventilation and ends with broken ribs from CPR and defibrillation. It also results in the scarring of health care providers who often must break their promises of a peaceful death.

Courtney is dying one of the worst deaths imaginable, and we promised her she wouldn't have to die this way. Her heart rate has been in the 40's several times today, but she continues to exist on this earth, as her toes and fingers become necrotic from the vasopressor doses she is requiring to maintain a blood pressure. (Distally, Dopamine shuts down peripheral circulation to maintain it centrally). Her colostomy stoma is now black as her bowel dies. The vent is on a PRVC of 30, which means she is receiving 30 breaths a minute at a set pressure and volume.(Sit and try to do that for a minute through a large straw). The graft across her abdomen has died and is tearing off, leaving a cavernous area that extends to her spinal column. The smell of rotten flesh can no longer be contained. She is on a 2000 pound air bed to try to keep her from rotting further.

Laura is a wreck and there is not a thing we can do legally. The nursing staff has considered some things we could do, but are stopped by the thought of what God would think. (We also contemplate what He thinks of us now). Life at all cost? No wonder no one wants to go into health care. This is the stuff they don't show on ER.

1 week later :

Courtney is still with us (in body). Brain perfusion is dramatically reduced when MAP's drop below 60 - hers is 40. Laura is dutifully and lovingly at her bedside night and day - now mentally and physically exhausted. The brother is held up in a hotel room. He visits a few minutes each day. The staff is numb to this now. Death will come, just not the way Courtney wanted.

If you want to write a story: push for families to talk more about difficult topics such as death. Encourage use of medical power of attorneys in families where there is (or could be) dissension. Living wills are pointless and offer false comfort to an individual if the family won't stand behind them. Encourage patients to talk to their health care providers about end of life decisions before they get into crisis. Health care providers don't like this topic and won't usually bring it up.

Most of us will have no choice in how we die. We will pass this world quickly or slowly depending on an endless set of circumstances that are as unimaginable as they are out of our control. But many of us will face the most difficult decision of our lives as we or our loved ones lie upon the threshold of deaths door. Hopefully we will have the clarity to look and to "listen" for a balance that not only allows for the possibility of God's grace, but also recognizes that his most perfect will is not always based in the number of hours or days we spend upon this earth.

Just this past weekend Sue worked with another patient who suffered perhaps longer than he should have. But in reflecting upon her experience she came to a new understanding of her role as a care giver and what "do everything possible" can mean to other people. Sue wrote :
I had a chance to talk to his family. His wife of 60 years explained to me that he had been "fine" up until 12 days ago, and that she didn't want to see him suffer but wanted to give him a chance. Suddenly I understood that the night we had just spent in constant motion trying to save his life actually meant something to them - regardless of how I felt about the inevitable outcome. It helped me come to the realization that these patients are not "ours"...but God's, and that he can work with whatever human decisions we make. I think "do everything" now means within the comfort of God's grace give this person an opportunity at life but also a voice if the end is inevitable. We must appreciate the uniqueness of each situation...

How do you wish to die?

I'm not sure - but I hope it is in the hands of someone like Sue.