MORTAL DILEMMAS

‘There is time for everything. Time to be born and a time to die.’- Ecclesiastes3:2 
 

“When we have overcome absence with phone calls, winglessness with airplanes, summer heat with air conditioning- when we have overcome all these and much more besides, then there will be two things with which we must cope: the evil in our hearts and death.”- Lament for a son, Nicholas Wolterstroff.

It was an unusual day in many ways. We had wrapped up neurosurgery OR by 4:30 pm and I had just visited my sister in law who was recuperating from a surgery. As it has become my habit now I religiously looked at the following day’s list. There was a 54 year old lady for the excision of a kidney mass in the schedule and since she was admitted in the next ward of my family member, I decided to have a look at her.

A short plump woman lied on the distant corner of the ward with head propped up and body curled under thick blankets. The two sons were sitting next to her bed chatting indistinctly. As I approached them and introduced myself the elder son acknowledged and narrated his mother’s woes.

The family was from Bangladesh and arrived with meager resources.  The mother developed massive heart attack and was hospitalized 7 years ago. The heart doctor put a stent in her arteries to augment the blood supply to her heart. It was also diagnosed that her heart had a huge hole and the blood was not flowing in the right course it generally should. As a result she felt very breathless and was on multiple medications. Adding insult to the injury, she had developed abdominal pain and a CT scan showed she had a kidney mass that requires surgery.

Anaesthetizing a patient with so many illnesses is opening a Pandora’s Box.  And that was exactly what we were going to do the next day. In the rigmarole of eliciting her story I noticed tears rolling down her senile cheeks. She spoke at length in Bangla and the only bit I could decipher was her unwillingness of the surgery. The anesthesiologist had already explained the huge risk of the procedure to the son. The son a middle aged lanky figure stood nonchalantly nodding as I reiterated that his mother may not even survive if things go wrong. He just said ‘My mother does not know anything sir. You go ahead with the surgery!”

Modern medicine can flaunt many advances. We have stretched our capacities so much that we can prolong life that our previous generations would rank only absurd. In our own centre we have kids less than 900 grams making it out fit and healthy with operations done in nonagenarians regularly.  One Sunday we had a 103 year old lady who came for surgery and her great grand son gave the informed consent.  Thanks to the technological expertise, organ systems can be made to work till you wish. We have ventilators that take over the function of lungs. We have artificial pacemakers which make the heart beat and dialysis machines that purify the blood off the metabolic wastes. But is a group of organ systems working together life? we have prolonged the years of life but have we improved their quality?

The next morning our lady was rolled in to the OR. She was still anxious. Thankfully our new non PG was well versed in Bangla. We tapped into his linguistic skills and assuaged our patient’s worries. Defibrillator was kept ready- the shocking device for terminal medical formalities. Emergency drugs were loaded and ready. Intensive care unit was informed. Blood was received from the blood bank. Surgeons were again informed of the anesthetic mayhem this lady can turn out to be and they had to be quick and precise. 

I could not help but ponder about the son of the patient.  I put myself in his shoes. If my mother is in a terminal procedure like this one may turn out to be, would I allow it? Who has the ultimate prerogative to make health choices when the patient herself is not informed enough to do so?

 In our culture death is a forbidden subject, but it is a sure climactic reality. Our life is spent on preparations- for school, for career, for marriage, for children and for retirement. But when it comes to death, we are all so silent. We talk about property and wills but somehow we are not ready to ask our parents how they would want to die? The very thought causes repulsion and feels like a sadistic non-sensical avoidable discussion. But physical death is the final culmination of all life force.

  My grandmother died at home with all my relatives around. My father talked to her the night before and went to sleep. It being a summer vacation we were all having a gala time. At four in the morning someone realized that she was not breathing. How would I want to die if given a choice? Would I want to go to ICU with tubes in all orifices of my body being on full-fledged dependency or would I just go home to be with my kids have a sumptuous meal, listen to some good music and expire in the night when everyone is ready and no one’s awake?

The surgery began uneventfully. There was no complication two hours into the procedure. There was some bleeding that was controlled by timely cautery. In three hours the diseased kidney was out, the patient reversed from anesthesia and rolled out to the recovery. The son looked happy and was vindicated on his decision. 

What would the son have thought if the outcome was fatal? Would he have forgiven himself? Would you forgive yourself if a procedure your aged parent does not want takes an awful turn only because you have cajoled in it? That’s why talking about plans regarding end of life is good I guess. It’ ll avoid pangs of guilt and also honor the wishes of our loved ones.

The book of Psalms writes “Teach us to number our days so that we may grow in wisdom.”  Modern medicine has achieved many things. Not one of them is immortality. We will have to look to our creator for counsel on not just how to live but also on how to face the inevitable passage to behold God’s presence, which we call death.