It’s a hard truth, but all of us are going to die; every one of us.
A few of us will die peacefully. Less than one in five of us will die in our homes. Most of us will find our way into nursing homes and hospitals for our final goodbyes.
Even if we are diagnosed with an incurable disease, we will still, most likely, spend our final days undergoing burdensome transports between hospitals and tertiary facilities.
Modern medicine has given us seemingly endless options to rage against the dying of the light. In our last hours, our family will likely be faced with choices about medications and treatments that might prolong our lives. With those choices come hard philosophical questions about the gift of life and the meaning of death.
Beneath all of our life-saving rhetoric is the unspoken suggestion that perhaps we don’t need to die at all. Medical miracles come with a tantalizing illusion, the fantasy that perhaps we could live forever, or at least rage bravely to the very end. And in those final moments, emergency medicine is often called forth to be the soldiers in the last stand against death.
Is EMS prolonging life or death?
We see this frequently. Witness the elderly patient with a list of medications that runs for several sheets of paper. Weak and feeble, we haul them back and forth to dialysis, radiation and a battery of other tests and treatments with full CPR orders in hand.
Those CPR orders ensure that, if they were to be so lucky as to have a sudden cardiac arrest, we would diligently fight against that outcome as well.
Behind each intervention is a family member or loved one, hoping against hope that all of our medical miracles can buy the patient’s tired and withered body a few more days of life; perhaps another Thanksgiving with grandma, or one more fragile hug. Sometimes nobody in the patient’s inner circle of loved ones is willing to contemplate if all the suffering is worth the added time.
In these instances, it seems like nobody is stopping to ask the most vital question. Are we prolonging life or are we prolonging death?
For many of these patients, a life of health and wellness means not waiting at the end of their journey. To be clear, people still die from old age. People frequently live to an age where health and wellness is no longer a possibility. Comorbidity of disease has guaranteed that this aliment will be followed by another and then another until one event is finally enough to topple the house of cards.
There is a name for this biological process. It’s called senescence and it occurs in all living organisms. Cells die off at ever-increasing rates; organs become increasingly less effective; and systems begin to fail.
It is as relentless as it is inevitable and, for us in EMS, it poses a unique challenge. How do we decide when to fight against death as an enemy and when to embrace it as a friend?
We are, after all, in the business of life. Speaking of death as a viable alternative to some disease processes isn’t a popular notion in our industry.
But the longer we push the subject away, the longer we are forced to bear the burden of our secret: Sometimes we in emergency services add more life to people’s lives, and sometimes we steal the dignity from people’s deaths.
When we train civilians in CPR we tell them that there is one and only one option when an individual stops breathing. Dial 911 and begin CPR.
Not fighting against the possibility of death seems absurd. Why wouldn’t we battle? What was common place and acceptable 80 years ago is now unthinkable. Many people simply aren’t allowed to die beautiful deaths, surrounded by loved ones and saying their final goodbyes.
The misconception of medical immortality
We educate the culture to believe that death outside of a medical institution invariably involves sirens and lights, tubes and broken ribs and waves of other indignities. That isn’t to say that these treatments don’t have their place.
All of our medical interventions have their place, but we could do a much better job educating our culture in their appropriate use. Instead, we frequently allow our culture to vastly overestimate the power of modern medicine to prolong their lives and cure their ills.
When we imply that a stage four CHF patient should be taking Lipitor or a terminal cancer patient should spend half of his remaining time hooked to a dialysis machine, we only fuel the misconception of medical immortality.
As it turns out, medical immortality is one of our most powerful illusions. If we’re to be honest, we’ve pedaled a lot of snake oil to the masses over the years. From backboards to emergent transport and helicopters in the sky, we’ve put on quite a show of smoke and mirrors.
But none of our illusions are more powerful than the illusion that we can prolong your life indefinitely. It’s the illusion that, if all the stars line up, we can squeeze more life into your life and those additional days will be worth the fight.
Adding to the complexity of the issue is our own fragile mortal coil. We are all so scared of our own mortality that we’re more than happy to let the machine keep turning.
We gladly turn a blind eye to all of the additional suffering we cause with our life (death?) prolonging interventions. We choose to believe our own mythology because we want to believe it’s true just as much as the next person.
Can EMS put dignity back into dying?
I’m not hopeful that we will ever reverse the wheels of our most powerful illusion. Eliminating backboards will take years. Helicopters will take even longer.
But what if we did decide to lead the charge in putting dignity back into the process of dying? What would it look like?
Could we be bold enough to suggest that it might be appropriate to not transport a dying patient to the hospital? What if we were brave enough to suggest that further treatment might not be caring for a patient but creating more pain and suffering? What if we were better at helping people say goodbye?
Interjecting that kind of boldness into our medical response systems would be a monumental task. It would be a change fraught with controversy as we clash over our differing views about the meaning of life and the purpose of death.
It would also begin with each of us swallowing a bitter pill of understanding as we collectively admit to ourselves that sometimes, being saved by us is worse than death itself.
