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January 12, 2012
Sometimes death barges in; sometimes he waits patiently at the end of the bed.
Always ready to lend a hand, death comes along for the ride as the partygoers
pile in the car. Everyone is having fun and the driver has probably too much
booze. Or, as life slips away from a failing mortal shell, death takes charge.
Retired Kamloops Doctor Russ Reid is familiar with death. In his years of
practice, he has seen death's ways. Dr. Reid says that death can be kept at bay
when the chances are good. "In the case of a relatively young and otherwise
healthy individual admitted with a heart attack," he explains in his column in
the Daily News, "CPR would always be indicated in the event of cardiac arrest."
In that case, death will have to wait.
Not so in other cases. Dr. Reid is blunt in his assessment. "In patients with
most other diseases the situation is quite the opposite - - the beating of the
heart and attempts to breath are the last functions to cease and when they do,
they signify that the body has been overwhelmed and is shutting down completely
and irreversibly."
Dr. Reid is also candid about the chances of resuscitation in the case of
cardio-pulmonary arrest in patients with severe emphysema and those with large
strokes. The chances are zero in these cases, he says.
While doctors may be familiar with death, patients and their families are not.
Families would prefer not to talk about death even as he pushes in. This leads
to denial or hostility when doctors explain why a do not resuscitate order is
attached to a patient's chart.
We, the living, don't take kindly to death's rudeness. We just want him to go
away. Doesn't the promise of technology and medicine give hope that death can be
beat? We want to deny that everyone alive today will die.
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Regrettably, some patients who are unreasonably and hopelessly resuscitated
are often left in the twilight zone between life and death - - neither dead
nor alive. Take the case of Hassan Rasouli, for example.
Rasouli has been in a coma at Toronto's Sunnybrook Centre since October,
2010. His doctors diagnosed him as being in a "permanently vegetative state"
and recommended he be taken off life support. His wife disagrees. She and
her family feel hope every time he lifts a finger or opens his eyes.
Doctors assert that Rasouli "is not receiving any medical benefit from being
kept on life support" and they are taking the case all the way to the
Supreme Court.
Medical technology can temporarily cheat death but at what expense? The
legal battle has been financially and emotionally draining for the family.
Rasouli's 28-year-old daughter laments: "You have your father in hospital in
a very critical situation and on the other side is the legal process."
All this grief could have been avoided if the patient, family, and doctor
had realistically discussed options at the end of life. One way to provide
more certainty at death's door is a "living will". While living wills have
no legal definition, they can direct the level of medical treatment you want
in the event that you are unable to express your wishes verbally.
In B.C., both a living will and power of attorney are combined in a legally
binding document called a Representation Agreement. We could save loved
ones, friends and doctors a lot of trouble by completing one. Frank
conversations before death's inevitable arrival should be more commonplace.
David Charbonneau is the owner of Trio Technical.
He can be reached at
dcharbonneau13@shaw.ca
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