July 2016 – Do Not Resuscitate

Originally published on KevinMD

They said, “Do everything.”

She knew something was wrong. And by the time she was 85 she had forgotten the names of her children, the town she raised them in, even the name of her deceased husband. In her 70s she was diagnosed with Alzheimer’s. Still coherent, she talked to her physician about becoming a DNR: do not resuscitate. She did not want to live on a machine that would breathe for her, she did not want CPR on her chest, she just wanted to go “home” peacefully. To go home to her Lord.

Instead of entering a nursing home, her son demanded on taking his momma home to live with him. So in her late 80s, she became more despondent, unable to talk, unable to feed herself, unable to go to the bathroom. And her son, who couldn’t wait to take care of her in his home, slowly, ignored all of her basic needs. He’d quietly shut her bedroom door. Johnny had to work. And Johnny had to play. He was too busy to turn her, too busy to clean her, too busy to feed her. And after two years in his home, sweet Mrs. Sally became contractured, bed-ridden and riddled with decubitus ulcers. A neighbor caught wind of potential neglect of Mrs. Sally and notified social services.

When social services arrived, they found Mrs. Sally laying in feces and urine, malnourished and her body cover in decubitus ulcers. Everywhere. Within due time, social services strongly encouraged Johnny to admit his mother to a nursing home.

Mrs. Sally arrived at the nursing home. Unable to eat, unable to talk, unable to walk, and her skeletal body lay in bed with permanent contractures.

Mrs. Sally was ready to die. Her DNR status was current, and the nursing staff gave her the best tender loving care possible. They made Mrs. Sally comfortable, as best they could. They held her hand and talked to her and cleaned her up. But Mrs. Sally never responded. Within a few months, Mrs. Sally showed more signs of deterioration. And one night, her breaths were so shallow, and her pulse was irregular and thready, that the nursing home thought she was dying. The staff made her as comfortable as possible and called the son to let him know that his momma was dying.

Johnny wasn’t ready to see his momma die, and told the nursing home staff to call 911 and send her to the ER. The staff reminded Johnny that his mom was a DNR. Johnny said, “bring her in.”

And so, the EMTs and paramedics arrived at the nursing home to take Mrs. Sally into the hospital. Since Mrs. Sally was now unresponsive, and unable to talk or to make any decisions about her DNR that she signed herself, Johnny was able to rescind the DNR.

And upon arrival to the ER, Johnny and his sisters burst through the ER doors screaming, “Do everything!”

Upon admittance to the emergency department, Mrs. Sally had a thready pulse and gasping respirations, sometimes agonal. Within minutes, a code blue was called overhead in the ER. Mrs. Sally lost her pulse, she was straight lining and had no respirations.

And against our morals, against our compassion, against our need to have dignity to this little lady and her last days on earth, we presented her with rapid CPR compressions; we felt her tiny ribs crunch and break, and her heart rate speed up to a chaotic fibrillation. Ventricular fibrillation is announced by the ER nurse, and she screams, “all clear,” as we force an electrical current through her heart. And we watch her have seizures and loss of oxygen to her brain and leave her with a faint thready pulse and too much time for no oxygen to her brain. And she “survives” these insults that we forced upon her, leaving an anoxic brain in her contractured body.

And the family is pleased: “Praise be, she’ll live to be 100.”

And we, the EMTs, the doctors, the ER nurses and the ICU nurses, bow our heads, because we know we brought torment and pain and assault to this tiny, malnourished lady, who once had a vibrant life. Who once had a full life. But slipped into the tunnel of dying. Almost peacefully, until her family forced us nurses, us EMT and paramedics, us doctors to bring her back. And instead of Mrs. Sally going to her heaven, instead of being in her heaven, and resting in peace forever, We condemned her to a living hell.

Prepare your moms and dads and grandmoms and grandpas and allow them to drift peacefully into that other world.

It is not heaven on earth. It is a hatred left here on earth. A hatred that is hell-bent.

Two days later, Mrs. Sally died on a ventilator in the ICU. We were unable to bring her back.

And her family that said, “Do everything,” were nowhere to be found. Her nurse held her hand, as Mrs. Sally died, on the ventilator with a bruised chest and fractured ribs from her CPR.

If your loved one has reached an end-stage of life, do the right thing. Let them die peacefully.

Originally published on KevinMD

Benjamin, Jr. was the apple of their eye. He was cute and inquisitive, and smart. Very, very smart. The minute he took his first breath into this world, his mom and dad had already ordained him as a future MD. He would become a doctor and follow in his father’s steps. No questions asked. He would become the second MD in the family. Every birthday, his parties were doctor-themed: kiddie stethoscopes, pretend syringes, colorful doctor-like toys.

Each year, Ben grew taller, handsome, muscular, and loved airplanes. He grew into a good looking young man. In high school, he excelled in the sciences and math. Chemistry, biology, calculus, physics. He tutored kids older than him. Nothing was too hard for Ben. He was the small town hero. He brought his high school to fame as the star quarterback of the year. Chiseled face and body, he was everything to his parents, Benjamin and Sally O’Malley.

The girls loved him because he was a manly man, but kind and gentle and polite. The guys loved him also. As he was everybody’s best friend. He was everybody’s champ. Awards came naturally for Ben. And on his graduation day, the scholarships were plentiful. Football scholarships, math and science scholarships, and he was able to pick and choose which college he wanted to go to.

Early on, as an only child, Ben’s parents knew that he was brilliant. He could put a difficult puzzle together in minutes. He could recite math flash card equations with a blink of an eye. And his parents knew: A doctor was born.

As Ben grew older, he went along with the idea of being an MD. He loved pleasing his parents but he knew if he told them that he really wanted to be was a pilot, there would be repercussions. He knew that if he questioned his future to his parents that this was not what he wanted, he would face anger, and then silence and then near non-existence. He wanted to fly those friendly skies. And he knew he would want to be a pilot one day. Not a doctor.

Though Ben lived a very comfortable life, as his dad was a neurosurgeon, he certainly didn’t need any financial assistance for college. But the scholarships rolled in. And instead of Ben wanting to train to be a pilot, his dad chose his alma mater. Ben would go to the college his dad went to. And he would major in biology and then according to Dad’s plan, he would also become a neurosurgeon.

Just like Dad.

In the summer months, Ben would take flying lessons, and figured he would settle flying as a hobby. He knew that if he didn’t go according to the “plan,” his parents would cut him off. Financially, and mentally. As loving as they were as parents, in a split second, they could turn cold as ice. Freezing cold.

So Ben earned his bachelor’s degree in biology, and then he endured four more years of medical school. He worked hard as a student, he also worked hard at not falling in love. And each year in school, got harder and harder, and he felt more isolated and lonely, always pleasing his parents with the best of grades. He came home for the winter holidays and put his “mask” on. The mask that said he loved medical school, the mask that said he loved staying up all hours in the hospital tending to endless patients with endless medical problems and complications. The mask that said he dated once in awhile but hadn’t found “the one” yet, the mask that said he couldn’t wait to do seven more years of neurosurgical residency training.

Ben grew more and more distant from his friends, his buddies, his patients and his parents. He spent sleepless nights and then would have to wake up early and start the day over again, studying, patient assignments and rounding, tests and papers and the list of “to-dos” was endless.

Ben was exhausted and realized he never wanted to be an MD. He realized the pressure his parents put him through year after year. He had to be perfect. He had to make As, and he realized he was trapped, and his parents dictated his life, the minute he was born.

And he felt no way out. No escape. And he’d look up into the skies and realized he would never be that pilot, that love for adventure and blue skies and places that he dreamed of going to would never happen. His dreams were never recognized. Never respected. And instead of growing angrier at his parents, he became quiet and distant. After eight years of grueling college, he finally became an MD. As they called out his name, Ben walked slowly across the stage to accept his medical degree. Top of his class — they called him “the whiz” — Ben took his boards and passed with flying colors. As he slowly unwrapped and unraveled his certificate announcing:

Benjamin O’Malley, Jr.
Doctor of Medicine

He finally achieved what his parents had demanded of him. And now seven more years to become a neurosurgeon.

Ben Sr. And Sally noticed that their Ben hadn’t been home in quite awhile. They noticed that he didn’t answer his phone when they called over and over again.

But within two weeks, a package showed up at the semi-mansion of Dr. Benjamin and Sally O’Malley. They were thrilled but puzzled. They slowly opened the unidentified package. And they unraveled their son’s diploma. Fine parchment that elegantly stated Benjamin O’Malley, Jr. was now a doctor of medicine.

And inside this diploma was an eerie message scratched in a handwriting they did not recognize.

The note said:

I think this diploma belongs to you. I hope you will be happy with this.

Sincerely,
Ben Jr. (Doc Jr.)

Puzzled and confused they tried calling Ben over and over again. He lived thousands of miles away from his mom and dad so they couldn’t just jump in their car.

Several days later, a colleague and friend of Ben’s called his parents. Ben had not shown up for his hospital assignments. He was always on time, always early, always ready before anyone else. Always.

His colleagues called the police because this was not the Ben they knew. The condo door was unlocked by the manager of the condominiums. A raw stale smell penetrated the home that the police had to wear masks. They searched Ben’s home. High and low, all three stories, and there he was. In a closet, tongue protruding and engorged, cyanotic face and his neck. Roped and hanging from the closet.

Ben. The perfect son. The perfect MD.

Never allowed to be Ben. Never allowed to be that pilot. Never allowed to be who he wanted to be.

Dictated and manipulated to be the perfect son. Perfection. A life of no identity led him to his own death.

According to the CDC (Center for Disease Control), suicide is the 10th leading cause of death. In 2013, 41,149 people committed suicide in the USA.

People who commit suicide think their problems are unsolvable, and they feel completely out of control.

Feelings of pain, loneliness, rejection, abuse, helplessness, deep sadness, guilt, and depression are what they may be feeling when contemplating suicide.

Don’t turn your back to someone who talks of suicide. Get help. Don’t think their feelings will “go away.”

Month: July 2016

The family said, “Do everything.”

The perfect son. The perfect doctor.