How Do You Want To Live?

“She said she wants everything done,” “really?” I respond while walking into the patients room and not quite sure what is happening. I’ve been called in to see an 87 y/o female with end stage pancreatic cancer and to discuss “goals of care.” The patient has voiced to the physician that she doesn’t want her life prolonged by artificial measures but the daughter about flipped out upon hearing this. After much discussion and drama the patient concedes to follow her daughter’s wishes rather than follow her wishes for herself. “No one has asked my mom directly, so I asked her, ‘do you want to live or die?’ She said she wanted to live.”

From my experience most people don’t want to die. I take care of hospice patients and they don’t sign up with the thought of “I’m on hospice because I want to die.” In fact many of my patients are on hospice because they want to have as much quality of life as possible through the unavoidable journey of death. Do they want to die? Of course not, however they know they don’t have a choice and they’ve come to grips with this hard reality. Even my geriatrics patients have another generation to live for. There will always be a birthday, anniversary, childbirth, reunion, holiday, ritual, ceremony etc. to look forward to no matter the age.

I myself just had another birthday. Do I want to be one year closer to 40? No! But there is nothing that can be done to stop me from becoming a year older. I can deny it, ignore it, get angry or experience a whole host of other emotions; however nothing changes the fact that I am closer to 40. In this way, when people are faced with a NON-Curable condition and come face-to-face with their mortality, there will be nothing they can do to change that. The real question is not, “do you want to live or die?” rather, “for the time you have left, how do you want to live?”

The following is a great quote from an unknown author.

“You only live once.

False!

You live every day, you only die once.”

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Trach and PEG

There I was in ICU rounds (the Palliative Care Team attends ICU rounds) shaking my head as usual. One of my nurse practioner students told me she disliked going to ICU rounds because it was like a “Nursing Home.” She was saddened to see so many geriatric patients, in the ICU, mostly with a poor overall prognosis. The words “Trach and Peg,” ran through my mind for hours after rounds because so many patients were being “Trached and Pegged.” Those words brought so many negative emotions and feelings; sadness, fear, isolation, pain and suffering to name a few. The words and images burned into my mind, that for the rest of the day it was like a song that haunted me…”Trach and Peg, Trach and Peg.” The words bothered me to the point that I had to write the following:

“Trach and PEG”

“Trach and PEG”

Those words sound horrible in my ears.

Unknowing to families an artificial prison for months or years.

The family will never know what to expect.

Bedsores, UTI’s, pneumonias, you name it, continue to occur even without neglect.

Most families doing the best they can,

thinking that this is the best plan.

While I make rounds in the ICU

will the patient suffer through another code blue?

“Trach and PEG”

“Trach and PEG”