Removing the line

by Andrea Powell, HPCCR Marketing Manager

draw-the-lineI read an article today that perfectly illustrates an important point that hospice organizations always try to drive home: hospice care is about what the patient wants.  It’s glaringly obvious when you read this insightful piece that sometimes what the patient wants might be completely unexpected and furthermore, might be in conflict with what the physician wants for that patient.  The truly compassionate doctor, however, will bypass their own judgments and opinions and do everything possible to accommodate the patient’s wishes.

The author, a hospice and palliative care physician, tells the story of “Ms. Weatherby”, a 57-year old hospital patient whose lungs had stopped working due to various diseases.  Ms. Weatherby was intubated, meaning she had a tube inserted into her throat and down her trachea, to help her breathe.  To say that intubation is uncomfortable, both physically and mentally, is an understatement.  But there was more.  She also had a feeding tube (through her nose) and a myriad of other tubes to help her with other daily functions.

Now, if this were me, I’d be miserable.  But apparently Ms. Weatherby was in fantastic spirits, very positive, and had her laptop open along with blank journals surrounding her, ready for her pen, so that she could communicate with her family and friends.

After several days in the hospital, the doctors were able to take the breathing tube out for a short period of time.  Ms. Weatherby was asked if, when her lungs weakened again, she would want the tube reinserted.  Her response?  An unequivocal yes.

Ms. Weatherby’s other doctors were incredulous.  They simply couldn’t understand her decision to be drastically uncomfortable during the brief amount of time she had remaining.  But her hospice physician wrote something in the article that resonated in its simplicity and virtue.  She said, “When advanced life support becomes comfort care, where do we draw the line?  Based upon what I learned from Ms. Weatherby, I would argue that palliative care begins by removing the line.”

So simple.  So profound.  So right.

Apparently, Ms. Weatherby had important work in front of her yet to be finished.  She had a broken family at odds with each other and she wanted to fix that break before she died.  That was much more important than the discomfort in her lungs and the fact that the rest of her frail body was slowly shutting down.  So in the short time she had left, she chose to be kept alive with all that medical technology had to offer, taking pure delight in very simple comforts — the ability to brush her teeth, warm socks on her cold feet, and communicating with the people she loved.  For her, that was enough.

I think the last thing any of us would want before we die is to be criticized for the final decisions we make.  Honoring last requests, no questions asked, is a very basic right as far as I’m concerned.  Ms. Weatherby’s hospice physician would maybe not make the same decisions if placed in that particular scenario, but she unfailingly honored her patient’s wishes.  She removed her judgments and biases from the equation.  And thus, she removed the line.

Explore posts in the same categories: advance directives, awareness, end of life, hospice, palliative

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