INDEXING TITLE: DCHUA'S MAR [5-06]

MAR Title:

Suffer the Living 

Date of Medical Observation: June 2005 

Having power over death, it is ironic that every physician eventually has his own story on how he failed the ones that gave him life.  (Insight Psychosocial Discovery)  As far as I can clearly remember, my 70-year-old father has had cerebrovascular disease.  He suffered three successive strokes, the last one confining him to a life of complete dependence. 

A from-work duty weekend saw me sleeping in the middle of the day.  I was roused from sleep, like I was decades ago when my dad, 200 pounds heavier then, fell down the stairs, sustaining some head lacerations.  This time, he had fallen down from a wheelchair.  I found him unmoving, face down on a pool of blood, like a caricature from a murder-mystery.  Lifting him with the help of neighbors, I noted that his previously hunchbacked neck had straightened out.  The ambulance was quick to arrive but we had to search for a cervical collar for over an hour.  At the hospital, I stitched up a large forehead laceration and confirmed the cervical neck fracture with x-rays.  (Insight Physical Reinforcement)  With progressive difficulty of breathing and swallowing, I had him placed on a mechanical ventilator.  No one was able to insert a nasogastric tube for nutrition as the days passed by.  I needed a consensus from by siblings on the question of how far we would be willing to go.  They answered the call, reuniting for the first time in years.

(Insight Ethical Stimulus)  How aggressive would we be in treating a patient who had requested for euthanasia everyday for almost a decade?  Was surgical access for air and nutrition ordinary or extraordinary measures?  Would I want myself imprisoned in a mockery of like, with minimal motor and sensory capabilities, while enduring unending days of pain and isolation? 

Each of my siblings reacted differently.  The eldest struggled with the medical jargon and implications.  My sister broke out in tears, blaming my dad for not taking care of his own health.  (Insight Psychosocial Discovery)  The middle brother gave us the answer by throwing the question back to the patient.  He asked my dad if he would wait to meet his future wife.  My dad nodded a yes. 

The will to live is based much on prevailing emotional support.  My dad was happy to see all his children again, and to know that they still cared to come at a moment’s notice.  Did he realize that the situation was ephemeral?  He would return to the same home, in the same broken shell, with the same exhausted caregiver, in the same dysfunctional relationship with his family.   

Should one humor a deluded patient with false hopes, or assist a major depressive disorder patient with his wishes of dying?  Quality of life depends on the state of mind, which in turn depends on the existing support group of the patient.  Caregivers to frustrated debilitated patients require infinite patience, which is never achievable. 

Eventually, the patient underwent a tracheostomy, which continues to interfere with the care of the skin underneath the cervical collar, and which effectively took away his speech.  An NGT was inserted using endoscopic guidance, temporizing the problems with swallowing.  All the while, the glaucoma process exacerbated thru a previously failed surgical drainage, dimming the lights on this speechless, tasteless, motionless, painful existence for maybe another 10 years…