The Sad Truth of When Dying is Not So Easy For Some

"Craig Bowron is a hospital-based internist and a writer in St. Paul, Minn." who has written a compassionate essay on "the drawn out indignities of the American way of death" that recently appeared in the Washington Post. From craigs essay, it is easy to understand that the patients Craig sees have no control over their own lives. They suffer from 'living' in a nation whose medical practice is devoted to keeping patients alive regardless of their requests for death or the wishes for an ending to the pain their their loved ones request. As human beings, they deserve, I believe, the right to say 'stop, I've had enough, I'm not going to survive without the aide of machinery that will keep me confined to my hospital bed like a prisoner.' With all due respect for the sanctity of human life some of us aren't so lucky. We all face an undetermined future that includes a moment when we all will succumb to death and some of us like the 'living dead' seen by Craig have been denied their right to a natural ending. I believe that in the matter of the hopeless patients attended to by Craig there are forces that have too much power being allowed to needlessly force a condition of 'living death' on people who do not desire or deserve such a fate. Craig takes "care for patients struggling through the winter of their lives." He sees "adult patients of all ages and complexities, most of whom make good recoveries and return to life as they knew it. But taking care of the threadworn elderly, those facing an eternal winter with no green in sight, is definitely the most difficult thing" Craig must do. "That's because" as Craig explains; "never before in history has it been so hard to fulfill our final earthly task: dying. It used to be that people were "visited" by death. With nothing to fight it, we simply accepted it and grieved. Today, thanks to myriad medications and interventions that have been created to improve our health and prolong our lives, dying has become a difficult and often excruciatingly slow process." To illustrate his heart wrenching point, Craig shares his thoughts on a number of patients under his care. "Take one of my patients." Craig begins: "She started dialysis six months ago at the tender age of 85, and the diabetic vascular problems that put her kidneys in the tank persist. One leg has been amputated above the knee, and several toes on her remaining foot have succumbed to gangrene. Robbed of blood, they appear dry, black and tenuously connected, like an ash dangling off a cigarette." She is receiving Craig's care "for a decreased level of consciousness and low blood pressure, but she has been having periods of nausea, and her appetite seems to have died with her kidneys. The initial workup revealed little, perhaps a low-grade bladder infection, but treating it and her low blood pressure doesn't seem to make much of a difference. She is withdrawn; food goes into her mouth, but she won't chew and swallow unless her children instruct her to. She intermittently refuses pills. There's a language barrier, but her children are there to interpret for her. Translation: She feels exhausted and weak, and she feels that way most of the time." Craig's diagnosis explains that: "This woman is suffering from what we call "the dwindles," characterized by advancing age and illness. Although dialysis is a miraculous technology -- she'd be dead without it -- it exacts a heavy toll from someone her age or with her medical problems. Three days a week are spent in dialysis, and the other four are spent recovering. It is extending her life, but she's miserable." She is an example of a 'living dead' person. "Her family has designated her "full code," meaning that if her heart stopped or she were to cease breathing," medical attendents "would do CPR to revive her, even though there would be a very slim chance of success -- and even though" as Craig describes; "it would be God's or the universe's way of giving her an easy way out. Another patient" being seen by Craig; "is in even worse shape. He's 91 and still a very big man. When I enter his room to examine him, he seems like a giant oak felled into a hospital bed, stiff and rigid, with swollen arthritic joints. A stroke four months earlier paralyzed his right side and left him bed-bound and nearly helpless, with pressure sores on his heels. He is mildly demented, and the pain pills aren't helping. He was brought to the ER because he was thought to be having another stroke, though these new symptoms quickly resolved. Talking with this patient," Craig recognized "his face and the Cajun accent;" Craig explains: "I'm certain that I took care of him sometime in the past, but he is not the man he was then. Staring at his 230 pounds stretching the length of the bed, I wonder how difficult it must be to care for him. To transfer him to a toilet or a chair requires the use of a Hoyer lift, a gigantic sling that's wrapped around the patient and attached to a mobile mini-crane. Fully suspended, he looks like a massive baby being delivered by a giant stork. The contortions and gymnastics of getting him slung up and moved must drive him wild with arthritic pain." Craig has spoken with the old Cajun's son, his primary caregiver when the old man was at home; before his son realized he was unable to care for his father and had him admitted to Craig's Hospital. Craig admits that there is nothing; no preparation in his "medical training" that "qualifies" him "to judge what kind of life is satisfying or worth living. Many would say that if we were to become paralyzed in an accident, just let us die. But many quadriplegics, once they've gone through an initial period of adjustment, find their lives very satisfying. Patients can and do make enormous efforts and fight precipitous odds to get back to life as they knew it, or even just to go on living. But the difference for many elderly is that what's waiting for them at the end of this illness is just another illness, and another struggle." Another of Craig's many patients "has 86 years behind her and was brought to our hospital from a nursing home in the wee hours of the morning. Her diabetes has become very brittle and difficult to control; the day before, paramedics were called because her blood sugar had dipped so low that she was becoming unresponsive. She also has dementia, and a couple of months ago, she fell and broke a hip. Although it was repaired and she completed rehabilitation, she has wound up essentially bedridden. Strictly speaking, losing your mind won't kill you: It's the falling, the choking, the weakness, the bed sores. This patient was brought in because the nursing home staff thought that she might have aspirated some food or secretions and developed pneumonia. She thinks it's 1982 and is, as we say, "pleasantly confused." She denies any and all symptoms, and her breathing looks comfortable. A review of her chart shows no fever and a normal white blood cell count. Her chest X-ray shows perhaps a subtle pneumonia but also a compression fracture of one of her vertebrae, which has gone from being 50 percent to 90 percent collapsed. Her dementia has mercifully spared her a lot of pain from the fracture, but it also keeps her from recognizing members of her extended family. Sometimes she doesn't recognize her own son, who drove to the hospital to be with her at this early hour." Her son and Craig "discuss what brought her in, and then we talk about her code status, which he confirms is Do Not Resuscitate. "She wasn't supposed to be brought to the hospital in the first place," the son tells Craig, "and puzzled, I ask him to say that again. She was never supposed to be hospitalized: Whatever troubles arrived, the plan was to deal with them in the nursing home. His mother had made that decision herself, several years prior to this hospitalization, before the dementia really set in. Later that day," Craig meets "with the son and a few other close family members. They want to continue the medications that would bring their mother comfort and discontinue all the rest. They aren't looking to end her life, but they aren't looking to prolong it, either. They can see that she is moving away from them in both body and mind, and they are ready to let her go." Dealing with so many 'living dead' patients must take a terrible toll on Craig's psyche, and he shares his thoughts: "To be clear: Everyone dies. There are no life-saving medications, only life-prolonging ones. To say that anyone chooses to die is, in most situations, a misstatement of the facts. But medical advances have created at least the facade of choice. It appears as if death has made a counter-offer and that the responsibility is now ours. In today's world, an elderly person or their family must "choose," for example, between dialysis and death, or a feeding tube and death. Those can be very simple choices when you're 40 and critically ill; they can be agonizing when you're 80 and the bad days outnumber the good days two to one. It's not hard to identify one of these difficult cases in the hospital. Among the patient-care team -- nurses, physicians, nursing assistants, physical and occupational therapists, etc. -- there is often a palpable sense of "What in the world are we doing to this patient?" That's "to" and not "for." We all stagger under the weight of feeling complicit in a patient's torture, but often it's the nurses who bear most of that burden, physically and emotionally. As a nurse on a dialysis floor" once told Craig, "They'll tell us things that they won't tell the family or their physician. They'll say, 'I don't want to have any more dialysis. I'm tired of it,' but they won't admit that to anyone else. This sense of complicity is what makes taking care of these kinds of patients the toughest thing" that Craig must do. A fellow physician told" Craig, "I feel like I am participating in something immoral." Another asked, "Whatever happened to that 'do no harm' business?" If we can be honest and admit that we have no choice about dying, then the only thing we do have a say in are the circumstances. Like many nursing home patients, Dorothy was on the cholesterol-lowering medication Lipitor. Why? So that she wouldn't die of a heart attack or a stroke. But don't we all die of something?" Craig realizes that: "Everyone wants to grow old and die in his or her sleep, but the truth is that most of us will die in pieces. Most will be nibbled to death by piranhas, and the piranhas of senescence are wearing some very dull dentures. It can be a tortuously slow process, with an undeniable end, and our instinct shouldn't be to prolong it. If you were to walk by a Tilt-A-Whirl loaded with elderly riders and notice that all of them were dizzy to the point of vomiting, wouldn't your instinct be to turn the ride off? Or at the very least slow it down? Mercy calls for it. This isn't about euthanasia. It's not about spiraling health care costs. It's about the gift of life -- and death. It is about living life and death with dignity, and letting go." Craig understands that: "In the past, the facade of immortality was claimed by Egyptian kings, egomaniacal monarchs and run-of-the mill psychopaths. But democracy and modern medical advances have made the illusion accessible to everyone. We have to rid ourselves of this distinctly Western notion before our nation's obesity epidemic and the surge of aging baby boomers combine to form a tsunami of infirmity that may well topple our hospital system and wash it out to sea." Craig sadly concludes: "At some point in life, the only thing worse than dying is being kept alive." After reading about Craig's patients and considering his thoughts, I admit that I have been thoroughly moved and dramatically affected about the levels of pain and suffering Dr. Craig Bowron must face on a daily basis. His is a special kind of courage that is unique to most Americans. I also admit that I felt anger for what the 'living dead' and their medical caretakers must endure. And I feel a sense of incompleteness given by Dr. Bowron on his example of "the facade of immortality (that) was claimed by Egyptian kings, egomaniacal monarchs and run-of-the mill psychopaths." I believe that sort of thinking is still with us today and in fact may cause more damage now than it did in the past. For I believe the ancient religions claimed by "Egyptian kings, egomaniacal monarchs and run-of-the mill psychopaths" has been assumed and fortified in people's minds by Christianity. And clearly demonstrated by the sad example of Terri Schiavo, who was forced to live in a vegetative state for several years. The force behind keeping her in such distressing conditions was the powerful influence wielded by Christianity whose machinations fueled the protests to 'keep Terri alive' by various advocacy groups and numerous pro-life Republicans. Christianity constantly forces its 'pro-life ' agenda on Americans every moment of the day and emphasizes the 'sin' of ending 'life' which scares feeble minds and charlatans to accept and use Christian propaganda as fact. Taking one's life by any means is not an option for the fanatical teachings of Christianity. Yes, I blame the misplaced and unnecessary power and influence flaunted by Christianity over our nation for the sufferings of the patients Dr. Bowron and the numerous other health providers like him must suffer along side with each day. I do not blame Dr. Bowron and others like him for failing to condemn Christianity's power over life and death because Americans have allowed the fanaticism of Christian dogma to rule our lives to the point that if anyone, including Dr. Bowron were to speak out against the insanity of the taking of a life of a patient such as those seen by Dr. Bowron and others; the Christians would enact all the considerable power at their disposal and banish Dr. Bowron from his practice of medicine. We live in nation that is under the dictatorship of Christianity and the time for sensible people to speak out and gather strength by banding together to end the insanity imposed over the ending of the 'life' of the 'living dead is long past due. Christianity is an ancient religion that must no longer be allowed to make all decisions regarding life and death in a modern world where "democracy and modern medical advances have made the illusion" of everlasting life "accessible to everyone" and anything less is a 'sin' condemnable by an eternity of pain and suffering. What Dr. Bowron's caring and thoughtful essay has taught us is that we, as a nation are already forcing what must seem like an eternity of pain and suffering because of the unecessary combination of modern medicine governed by fanatical Christianity.