Broken survivors

Charles Cowling

Watch the full episode. See more FRONTLINE.

Superb if gruelling documentary examining end of life issues from PBS.

One of the contributors is Judith E Nelson, professor of medicine at the Mount Sinai School of Medicine and associate director of Mount Sinai Hospital’s Intensive Care Unit:

The burdens of intensive care can be very, very heavy, and the outcomes are often not good. So we have to face this extraordinarily difficult challenge of knowing when to use this miraculous technology and for how long and knowing when to try to preserve for people a peaceful and dignified process of dying. Walking that line is the very hardest part of my job, and constantly recalibrating myself from one side of it to the other.

Although we can never be 100 percent certain until the moment of death that someone is dying, there are clinical situations where the odds are so overwhelming that someone can[‘t] survive the hospitalization in a condition that they would find acceptable, that we can see that outcome and compare that with the burden of the treatment. When it is virtually a foregone conclusion that that unacceptable outcome is going to occur, then using this technology to support the physiology of the patient doesn’t make sense. And it is invasive, and it’s burdensome.

It’s a situation in which a person is completely dependent for all of their care on a nurse and a physician; where the patient cannot even attend to their most personal care and has to be cleaned from head to toe and every buy cialis new york place in between by another individual; when they’re not even awake. And our nurses do that in the most unbelievably respectful way, but still, it’s a part of this experience. It is being attached to machines with constant noise from alarms and signals. It is being surrounded by electrical devices and monitors, with no control over any of your bodily functions, quite literally. And although we strive as hard as we possibly can to prevent discomfort, it’s probably impossible to prevent it at every moment. So there are discomforts, and one hopes rare but occasional pain and other kinds of distress, fear, delirium. All these things are occurring for people.

In addition to that, you’re in a bed that has side rails to protect you from falling, but also may make it more difficult for the people who love you to get close to you. Even if there’s open visiting in an ICU, which some ICUs have and some don’t, it is not a place where loved ones move about freely. They’re uncomfortable and unhappy and fearful. And all of that is part of the surrounding. So it’s a very disconnected, depersonalizing and occasionally even painful and frightening experience. I don’t think anybody wants to die that way. I think most of us, not everybody, but most of us would be willing to go through it for a good outcome, but nobody wants to be like that if nothing good is going to come of it.

Full interview transcript here.

One thought on “Broken survivors

  1. Charles Cowling
    Perpetua's Garden

    I see two critical points here:

    1) the first is obvious: that the person dying has full information and full choice, assuming they are still able to make decisions. Nothing else should be more sacred to us than the choice over own life and death – NOTHING.

    2)that deciding whether the outcome is good or not depends not only on what will likely happen on this side – the alternative must also be considered, and that is different, depending on one’s beliefs.

    A believer may well make the decision to go before the atheist who has nothing except “this side”. For the latter, it is a far more difficult choice – pain/indignity etc or nothing.

    This second point is constantly overlooking in these discussions, which assume it is this side or nothing. That is not the reality for some people (perhaps for all of us, who actually knows!)

    Thomas Friese
    http://perpetuasgarden.org


    Charles Cowling

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