it's a brave new world

Not rude at all. This is a VERY good question, because most people honestly don’t know. And I’m incredibly happy that you asked!

I going to explain in the most straightforward way possible, the way I tell patients and their families. 

So, being on life support is not gentle, nor is it comfortable. Being on life support requires machines becoming part of your life. 

Let’s focus on intubation. Your breathes are controlled by a machine, via a hard, plastic tube that must be placed down your throat. Plastic isn’t meant to stick in your throat. So it causes inflammation, irritation of your throat. People who get actually get extubated will tell you, it is VERY uncomfortable, even with the sedation and pain medication provided. Intubation also carries it’s own risks. It puts you at risk of pneumonia, lung damage, and if placed for too long, your muscles weaken because you are not exercising them to help take your own breathes. 

Okay, let’s now talk about the connection of dying with dignity.

I first want to say there is nothing inherently wrong with life support technology. For those who have diseases or trauma that have a high chance of recovery, the employment of this technology is only temporary. They help make recovery possible. The frequent poking of needles to insert catheters, the constant suctioning of sputum from one’s mouth, are worth it because the good (recovering and going back to your normal or near-normal self) outweigh the bad that the technology causes. The only time these life supports’ good do not outweigh the bad is when a patient does not have a good chance at recovering a meaningful life after all of these interventions are through.

Imagine yourself in your loved one’s position. You are already very ill and weak, that is why you are in an ICU. So you already feel poorly. Being on a ventilator also means being sedated, because it IS so uncomfortable. So imagine yourself, in and out of a state of wooziness, with this hard plastic tube in your mouth, with at minimum your wrists restrained in soft foam cuffs, to protect yourself from you; in case you flip out and try to yank the tube out of your mouth (this is very common, because the tube is uncomfortable!) You can’t eat, not regular food. Nutrition is usually deliver as a liquid through a tube place down your mouth into your stomach, or through a drip into your veins. You must urinate through either a Foley catheter or in a diaper. 

When these machines and all of these complications and invasions, when this becomes your life and becomes a permanent fixture of the patient’s survival, this is where patient input and patient’s family input is incredibly important. All of these interventions: sedation, intubation, restraints, foley catheters, nutrition through tube feeds, just being in a hospital with other people who are ill, carries risk. 

We need you to help tell us what you think is a meaningful, fulfilling life. If life isn’t worth living if you can’t eat solid food, I want to know. If life isn’t worth living if you can never take a walk with your own two feet again, I want to know. I NEED to know. Back to my original post #202 regarding the angry cousin: he was mad at me because he thought I was telling them to decide if she lived or died. That is not what I’m asking. I’m asking about WHAT LIFE MEANS TO THE PATIENT. Because if you can still find meaning in life, bed-bound, sedated, intubated, restrained for your protection, etc. I NEED TO KNOW. If you don’t think so, tell me. I don’t want to cause harm, I don’t want to keep you from living or dying on your terms. Tell me what harm means to you, or what harm means to your loved one. Tell me what they think it means to live, what they think a good death is. If you love your loved one, you also don’t want them to be in prolonged pain that has minimal results. You want to respect their decision, honor their wishes.

I really should start making time to write on here more. My life has consisted with school, boyfriend, small social life, and sports. It doesn’t help that my boyfriend is in my class, I drink with my classmates, and I play intramurals with other med students. Medicine, medicine, medicine, all the time.

Sometimes I feel like I’m losing myself a little bit. I haven’t been writing much because I don’t know what to write. If someone were to ask me to tell them about myself, my answer would be “I’m wishbone-md and I’m a first year.” That’s it. What I’m going through doesn’t really make sense unless you’ve been through it yourself. I have non med friends that I occasionally see but they don’t have similar burdens weighing them down. I’ll try my best to write about these anchors more often because lord knows I need some catharsis.

We’re doing microbiology in class right now. I love that we’re actually doing diseases now as opposed to biochem and cell bio at the beginning of the year. Case studies are my jam, now that we’re talking meds and everything. I had a very rough start of the year because I would just avoid doing work since it seemed like everyone else was doing SO AMAZING and that people already took these classes. Avoidance is unfortunately my coping mechanism. I almost did not pass the module because I felt so bad about myself for a long time. But I’m doing better now because I like the stuff we’re doing and I’m getting more confident. It helps that we are moving into territory that classmates haven’t had in undergrad. I continue to hate rote memorization but it’s something I’m starting to accept as a necessary evil. I’ve gotta do it or I’ll perish and never match. Currently feeling out Firecracker and I bought Pathoma but I haven’t watched any of the videos yet. We’re gonna be tested on myeloid and lymphoid neoplasias soon. 

J.D. on Scrubs to Dr. Cox after his breakdown