Facing death

Ha Vu
Professor Jeffries
English 101
7 November 2013
Facing Death When I was little, my dad asked me: “What do you want to do when you grow up?” I answered without hesitation: “I want to become a doctor. Mom said that people would die if they get too sick and there were no good doctors. I would become one so that grandpa can live with us forever.” My answer then was reflecting the innocent thoughts of a child. To me, death and separation is the scariest thing. I could not imagine living a life knowing that somebody you love had left you forever. The ideas of not being able to see them again horrified me. Crazy as it may have sounded, I wanted to make humans immortal. As I grew up, I came to realize that it was not as simple as I thought. When I watched the PBS Frontline documentary titled Facing Death, I realized that I was too naive. Even with such modern medicine and all the rapidly evolved technology, people cannot live forever. In fact, the development of health care system sometimes makes it harder to decide to keep trying to prolong a life or not. All patients depicted in nearly fifty-four minutes of the documentary were struggling to stay alive. But it was a battle not many can win. We are not meant to be immortal. Dying is a part of life even though accepting it is not easy at all. The documentary aired on November 23, 2010, analyzes the issue of whether or not to sustain a patient’s life. Following the patients with severe illness, the documentary recounts a journey into the heart of modern medicine. In total, seven patients were mentioned in the documentary, each with different ailments and different circumstances. But they have one thing in common. They and their families would go to the edge of this. No one was ready to let go, neither patients nor families. There were a lot of things to take into consideration and everyone involved had to weigh the risk of death from the illness itself and from the procedure. Although nearly 100% of the patients chose to fight until the end, many lost the battle. It was the decision of sink or swim. “Today, more Americans die in hospitals than anywhere else. . . ”, acknowledged by the Frontline narrator. In my imagination, hospitals are where people with health problems come and have discussions with doctors to find the solution to their illness, receive intensive treatments and get better. Reality is much more complicated. According to Dr. Scott Lorin, Professor of Medicine, Harvard University, “95% of our patients cannot communicate”. Therefore, the decision of life and death was left to their health care proxies—their families. There were usually two options: to stay alive by depending a lot on health support, or to die. In some circumstances, technology could easily keep a person alive—literally, for years because, as David Muller at Mount Sinai hospital said, you can “keep their lungs breathing and keep their heart beating, keep their blood pressure up and keep their blood flowing . . . forever”. But we don’t know if this is what the patients want. We don’t know if this is an “acceptable” state of life to them. As Judith Nelson at Mount Sinai hospital said, they are “vulnerable and voiceless” whatever the decisions are. Nelson also stated that there are always approximately 100,000 people with chronic severe illness and on ventilators all over the country, and the “cost of caring for these people is in the $20 billion to $25 billion range annually”. According to Professor Jerome Groopman from Harvard University, their health care cost is considered a “waste”. The physicians and the patients’ families struggled with questions such as: What are the chances of surviving? Should we keep on with the intensive treatments or just give up and let them go? Dr. Keren Osman at Mount Sinai hospital believed that even if patients were suffering, there would be “a greater good at the end of it . . . they will come out the other side”. Patients with severe illness are at the edge of their lives and sometimes, all it takes is a little bit of courage and endurance to pull them back into lives. But no matters how well we knew, we couldn’t be completely prepared for the situations. Stopping the treatments could be a premature decision but at times, we fight till the end and still lose. In many circumstances, they wished they had given up earlier. Dr. Adriana Malone at Mount Sanai hospital said: “ . . . many therapies that we give you may affect your quality of life of may even shorten your life.” Take a look at Norman Smellie case. He stayed in the hospital for two months, suffering from the consequences of transplant’s complications. “He died a much more difficult death after the transplant than he would have died had he not chosen that.” (Osman). The intensive treatments amplified his pain unnecessarily. His family finally had to sign the DNR (do not resuscitate). Like Norman Smellie, John Moloney’s conditions also went down after his stem cell transplant, which his wife opposed to. But John, on the other side, declared: “Bomb me. I’d rather be like that then dead.” The chances of surviving might be low, patients will still go for it, because the “option of living is worth it”, said Celia Grosskreutz from Mount Sinai hospital. Many patients chose to fight against the illness. They refused to give up and do nothing. Malone said: “ . . . stopping therapy is not even in the mindset of the majority of our patients. Stopping treatment almost means that we acknowledge that death is near.” We cannot change the cards we were dealt, we cannot stop something that has already been started, but we can choose to fight or to give up. Imagine you gave in right from the start and let thing flow the way it wants, can you not ask yourself what would happen, what the results would be if you had taken action. You would be haunted by the ideas until you leave this world. Even though doing nothing is also a wise option, we should only consider it in the last minutes, when nothing else could be done.
You cannot deny that these diseases wear at you—both physically and mentally. And when no treatments seem to be effective and you are tired of the situation, you don’t want to push it any more. You walk a very fine line. According to Muller, the technology rapidly evolution brought along many therapies and treatments available. But when there are too many options and no one could be sure if the treatments would be helpful or not, they tend to do nothing, they tend to stand in the same place. Instead, they struggled till the last days of their lives with those unanswered questions. “What if we got more CAT scan? What if we explored this person’s belly one more time? There’s always the nagging concern in the back of your mind, ‘Have I really left no stone unturned?’” (Muller). It’s the downside to modern medicine. There is one more thing we need to contemplate: the survivors are not always perfectly contented with lives. They may have survived through their extreme illness, they can consider themselves lucky. But they are “broken survivors of intensive care” (Nelson). The decision of fighting till the end left many in the conditions that they don’t want to be in. Some would have to rely on machines for the rest of their lives. Some would go into coma or live in vegetative state for years.
The reality is complex—physicians and families have to weigh the risk of dying from the complications of the therapies or from the consequences of their patients’ illness. Medical cost, the chances of surviving, the possibilities of full recovery and the option of a good death, all had to be taken into consideration. I believe that no one with a heart could come the conclusion without waking up in the middle of the night wondering if they were doing the right thing. No one could easily let go of their beloved. But in the end, all of us have to. I had to accept that humans aren’t meant to live forever. This hurts—a lot.
Dying is scary. Losing your family members is much scarier. Letting go of them requires a lot of courage. It takes years for us to fully recover from the shock. But life goes on. Continuing to live in this world is our responsibilities—the survivors.