Sunday, November 09, 2008

some matters of life and death

This past Wednesday as we were making the rounds in our geropsychology practicum, we discovered that one of my classmate's clients is probably dying, and her son was in her room, making arrangements for her end of life care. Our class escaped into a small, uninhabited dining room to discuss end of life issues. Our most politically astute classmate informed us that in Oregon, a proposition to legalized physician-assisted suicide was voted into law. We discussed how this could become an option for more older adults, and how this sort of thing already happens under the table. Basically, in hospice care, people are sometimes given morphine "to be made comfortable," but in addition to comfort from pain, the morphine dosages actually quicken death. No one can call it assisted suicide because that's illegal, but physiologically, that's basically what it is.

I feel pretty strongly that any kind of suicide for any kind of reason done by any means is still a suicide, and therefore wrong. I believe that it is up to our Creator to decide when we live and when we die, but that line isn't so firmly drawn in many cases. Working with these older adults and their families and considering the failing health of my own grandparents, I feel like I need to be aware of and sensitive to these controversial end of life issues. And who's to say that there won't come a time when I have a loved one, terminally ill, no recovery in sight, who might consider measures to end their life on their own terms?

Every resident in the nursing home either signs a DNR - Do Not Resuscitate order or a Full Code order. Full Code means that in the event that their life ends, their heart stops beating, they stop breathing, all measures will be taken to restore their life. DNR means that these measures will not be taken. Looking at their medical charts, many of the residents I see have a DNR. As a healthy twenty-three year old, the idea of having a DNR sounds so foreign to me. Why would I not want the doctors to do everything possible to continue my life? But for individuals in their 80's, 90's, and beyond, many of them feel that when it is their time to go, they will go, rather than fight death to continue to live in an unhealthy physical state. For them, DNR is the natural choice, and Full Code seems unnatural. In way, having the choice between DNR and Full Code does mean that someone is making a choice about their end of life and the terms under which they want to live or die. It might be a stretch to compare this decision to physician assisted suicide as one is a deliberate act to end a life and another is a deliberate choice to not save a life, but both are choices that people make about their life and their death.

Last night, I joined my roommates in watching this past week's episode of Grey's Anatomy, a show that I had only seen one episode of previously. (If you haven't watched this and don't won't spoilers, skip the next two paragraphs) One of the stories of this episode featured an elderly couple, the wife of whom was having a dangerous cancer surgery from which she might not survive. McDreamy (no idea what Patrick Dempsey's character's real name is) tried to emphasize how life-threatening this particular surgery was, and seemed concerned when the couple dismissively replied, "Yes, yes, we know what we're getting into with every surgery." When the wife signed the DNR, McDreamy asked them if this was the choice that they wanted to make. They said that they did, that if it was her time to go, that it was her time and they didn't want to interfere. Then, the couple lovingly kissed one another and said, "Good-bye love," explaining to the doctors, "We do this every surgery. We say good-bye, and then when she wakes up, we get to say hello again."

The wife did not recover from surgery. When her heart stopped, her husband began pumping her chest to let it continue beating, and started crying out, "Help, someone, please, help my wife!" McDreamy and another doctor explained the DNR, and explained her wishes that that she not be resuscitated. He continue pushing on her chest, crying, "Don't leave me, please don't leave me!" As I watched this scene, tears filled my eyes. I couldn't believe that Grey's Anatomy episode was making me cry. The man continued pumping his wife's chest and eventually realized that there was nothing they could do. She would die. "I just don't want to be the one to let her heart stop." One of the doctors took over for him, but it soon became apparent that she didn't want to stop pumping this woman's heart either. Ever the hero (eyes roll), McDreamy took over, and slowed stopped pumping, allowing the woman to die as her husband sat next to her. It took a lot of effort to keep myself from bawling.

Then today, I sat on the grass under the tree in my backyard and first read some scripture, from the prophets Zechariah, Isaiah, and Micah, all about the coming Messiah, the coming kingdom, how the king will reign, how Israel will be restored, how war and idolatry and jealously will cease, how there will be joy and rejoicing. These scriptures fill me with such hope, and sitting in the shade, I looked forward to the day when those things are all fulfilled.

Then, I read a chapter from a book I've been reading called Grace (Eventually): Thoughts on Faith by Anne Lamott. The chapter was titled At Death's Window, and it's about her helping a friend with an assisted suicide and begins with the shocking first line, "The man I killed did not want to die, but he no longer felt he had much of a choice," and follows with a touching and delicate tale of a man in terminal stages of cancer who decides to end his life. I read several pages with mere curious fascination, until I read the line about how on the night he died, he asked his wife and friends to play his favorite CDs. Tears immediately filled my eyes, and I struggled to see clearly enough to read the last couple of pages describing the man's death. I finished, closed the book, sat still on the grass, gazing out at the leaves and trees, letting myself cry, pray, feel, and think. I tried to make sense of my strong reaction to this chapter and the Grey's Anatomy episode last night, and honestly, my emotional state is probably related as much to the time of the month for me (sorry guys) as it is to any other factor. The best thing that I could think of that made the most sense as I sat in the shade is that life is fragile, I am small, and God is big, but mostly that life is so incredibly fragile.


The Pensive Poet said...

This is a lovely post, Kelly.

I think your thoughts and your heart are in the right place, but I have to admit I feel a differently about physician-assisted suicide. My great grandmother was bedridden, on feeding tubes, and in a vegetative state in a nursing home for years. I never remember her being able to talk to me. In this situation, I would never presume to judge the actions of my family. I fully know that they did what they thought was best for her. But if I were her, I think I would have done something to ensure that I didn't have to live in a state of being like that. Rather than pulling the feeding tube and dying somewhat agonizingly like she did, I think I would have preferred to have some kind of physician-assisted measure performed before I ever got to that point.

crackers and cheese said...

Right, and I don't understand how allowing someone to starve to death is acceptable, legal, and "humane," but causing a painless, physician-assisted death is considered less humane than that. I'm sorry that your grandmother and your family had to go through that experience :(

Cara said...

This is a really complicated issue. I've told family members and close friends that I would like to go ahead and pass on, rather than spending life in a vegetative state. Death is so hard; of course I would want to do anything I could to keep loved ones alive until, like you said, the Creator has chosen to take them. But reading what you wrote (and the prophets wrote) about the full restoration that comes in Heaven makes me wonder why we hold onto this life so much.

I've only watched an episode or two of Grey's Anatomy, and I'm pretty sure I cried.