Saturday, October 8, 2011

Imagine . . .

. . . that you've been in love with someone for 2 years. Recently you are engaged to him; you couldn't be happier, life couldn't be more perfect.

Then out of the blue, he suddenly gets intense chest pain and belly pain. You take him to a nearby hospital. The medicine doctors spend 2 days trying to figure out what's wrong, meanwhile he gets worse and worse. Then they finally discover that he has an aortic dissection, and the worst possible kind at that! His aorta, the main artery that brings blood to the body, has split open from where it leaves the heart all the way down to his groin.

Your fiance is immediately transferred to a larger hospital in town, because leaving him where he is means certain death. The cardiothoracic surgeons manage to (miraculous) fix the aortic dissection in a grueling marathon of a surgery. Afterwards, the doctors notice that his legs start to hurt, swell, and turn dark. Immediately the vascular surgeons open up his legs to relieve the pressure and restore blood flow to his legs, hoping that they made it in time. Unfortunately, it was too late.

His legs are dying. They are causing him more and more pain each day, so much so in fact that it causes him to become delirious - he does not know where he is, he does not know what year it is, he does not know what's going on. He can no longer make medical decisions for himself. They turn to you, as his power of attorney, to ask if you would give them permission to cut off his feet. What do you do? What can you say? Cut off his feet in order to save his life (and his sanity)?

You agree. Days later, they come back and tell you that things are worse than they appear. More of his legs have died than they initially thought. They have to cut more off. They ask you to give permission to cut off his legs above the knees. What kind of decision is this? Your fiance will never walk again. But you agree to save his life.

And for the next several weeks, you get phone calls and every time you visit your fiance in the hospital, the surgeons find you and ask for permission over and over again to cut more of his legs off, because more has died and they can't predict or control it. What can you say? This is the person you love. This is the person you were going to marry! He no longer looks anything like his former self. But you love him . . . and you want him to live . . .
-----
This is the kind of story that I'm seeing more and more of on rotations. Being part of the care team detaches me emotionally from the situation. All we can focus on is doing what's best for the patient to help him live and move on with his life. But in the process, patients sometimes lose so much of themselves (literally) and family members have to make hard choices.

If you were the one making the decisions above for a loved one, how would you react? What would you do? Would you be strong enough to endure it?

8 comments:

R said...

mate that seriously sucks.

and i know what you mean when we (the med/surg team) get emotionally detached..

Max said...

That is such a horrible decision. I literally have a phobia of losing my legs, i love biking and swimming so much and without my legs it just wouldnt be the same. Idk what I would have done in the fiance's position....

A Wandering Pom said...

Aek

It's a heart-rending story (pun definitely not intended). As for what I would do if I were in that situation, I don't know. I very much hope I never have to find out. But my sympathy goes to all those caught up in it, both family and medical staff.

Take care

Mark

Biki said...

true love carries with the burden of living with someone who is less than perfect. and really what difference can a pair of legs mean if the loss of them allows your love to live?

my hubby used to apologize to me for the loss of his hair, he went bald really young. and ya know what i told him? i didnt marry you for your hair. and hopefully this person loves him enough not to care about things like legs...

Mind Of Mine said...

I wouldn't know how to react in this situation.

When reading this post I couldn't help but think about the burden the relationship would be under. But I don't know if I could stay....

That sounds terrible but I have never loved anyone that intensely.

E said...

Something like this is hard to read about, not mention witness, or even more terrible, be the one to have to make the decision. I realized years ago that if something happened to my parents ( despite having 4 siblings) that my family would look to me to make the decisions. I loathe the thought, but realize its a possibility.

I think detachment is the only way to preserve sanity with this kind of work. Teachers, social workers and lawyers (I have someone in each profession in my family) have also told me stories that are congruent to this with respect to their jobs. They find they must develop the same outlook toward such cases.

Aek said...

R: I'm not sure how I feel about being emotionally detached. It's a necessity, I suppose.

Max, A Wandering Pom, Biki, Mind of Mine: It is a difficult situation. It can be a severe disability to not be able to walk at all. And the stress that can put on a relationship can be great. But, there are certainly worse things . . .

E: It's a frightening thought, to be sure, to have that much responsibility. But I don't think that detachment is the only way to preserve sanity, just perhaps the most common one.

empty_spaces said...

Thats an extremely graphic and difficult scenario. I honestly don't think i'd be able to handle the situation and wouldn't be in any state to be able to make a decision.

I've got a friend at the moment who is on his death bed. He's accepted his fate and is in good spirits. His family have accepted it too, and they are already planning the funeral even when he is still alive! Its all too much for me to handle atm, so i wrote him a letter and had another friend give it to him. Since then I've just tried not to think about it.