Just for Today

Patients often come to my Hospice unit, with a prediction of imminent death. "If you remove the ventilator they will die," but they not always do so; "if you stop dialysis they will die," but they do not always do so.

It does not mean that doctors' training is faulty, it simply means that we are trained to make decision based on statistical probabilities, and life does not always proceed as expected. I tend to answer questions as to prognosis as honestly as I can, but try to add, that in my job, I "hope to be wrong more often." If the Creator tosses a proverbial "pie in my face," I need to have joy for my patients good fortune.

Recently we received two patients coming to our unit with aggressive life support, their blood pressures maintained by articial intravenous medications. In both cases, excellent specialists spelled out correctly what the numbers meant, and what the expectations were. If the medications were stopped, they "would die." And there is no question how the numbers looked. In both cases though, as in so many of these cases, continuing aggressive medication was not a panacea; first of all such modalities only work for so long - they are not ongoing answers or cures. And secondly, the patient in such a situation is "hooked up" - loses all sense of freedom.

In some cases, such as being on a respirator, the patient is unable to talk, and often needs to be heavily sedated to keep the machinery in place.

In both of these cases this week, the patients decided to withdraw the "life sustaining medication." Our intention is never to "end their life," but to affirm their right to choice and empowerment over their own existence, and to give them a chance, a hope, an opportunity, to live free of being "connected" or "hooked up." Being "open" to Spirituality, helps us turn a certain death into a chance for life. Even if that living is only for a short time, sharing love and memories with loved ones can be precious and important.

Usually - the docs are right, but not always. And fortunately, everyone was wrong in our recent "dobutamine" cases. Slowly we weaned the patients off the medication, and one of them actually began to improve. He became more alert, he started eating, he got up, and started walking around our unit. He decided it is "time to go home."

Our other patient who stopped his aggressive medication is still with us. He is surrounded by family with love pouring into him. When we cannot cure, we can join a family in caring, and in prayer.

This is a part of the nature of Hospice; accepting that we use our scientific skills as best we can, but that human life is more than lab tests and numbers. Sometimes we can do nothing more than make someone comfortable. But sometimes, we can do something more, we can have someone prove us "wrong," even if "just for today."