Saturday, April 23, 2005

Have the talk

I'm taking care of a survivor.

This is a 76 year old man who was playing hockey last week, and came in for an elective hip replacement. Unfortunately he had a heart attack right after the operation, and when the cardiologists tried to open up his coronary arteries, some clot broke off into his brain and caused several strokes.

When I first met him he was unconscious, with a balloon pump. That's a device that operates a long sausage-shaped balloon inserted the length of the aorta, so that when the heart pumps forward the balloon deflates to help forward flow, and when the heart is filling it inflates to help push blood into the tissues, including the coronary vessels themselves.

His prognosis was dismal.

We had a conversation with his son, who said he knew that his father would not want to live if he couldn't play hockey. He dug out a living will that said as much. This is a man who coached the game all his life and had a rink named after him. But the specific situations detailed in the living will were not quite relevant to the realities and decisions lying before us, and it was essentially useless to his poor son, whom we had to ask how hard we should try to save his father.

With his family, we decided not to artificially feed or hydrate him, and to take out the balloon pump after 1 day in order to see if he could survive. He did, and today he is awake, conversational, and able to eat and move his left arm. Nobody would have predicted it. He will never play hockey again, but he is glad to be alive.

Nobody can predict the future, and a few pages of words can hardly be an adequate guide to life and death without a trusted person in charge. I know we're all Schiavo-ed out, but that's why I wanted to take this opportunity to remind people to talk about these issues with loved ones now, especially that it's no longer a hot issue. The message we heard over and over throughout the Schiavo fiasco was exhortation to get a living will--but without having a confident understanding of your wishes, the odds are that your family will botch it, even if they're trying their best in good faith to honor your wishes. A living will is no substitute for having had a frank, detailed discussion with your loved ones about what you value, and to give them permission to use some judgment since they'll have to anyway. Do it today.

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