We all have our time machines. Some take us back, they're called memories. Some take us forward, they're called dreams.
~ Jeremy Irons
Recently I cared for a patient who was 88 years old, was independent, living at home by himself. Would perform his daily living activities by himself. He would drive himself around to places, was social at the same time. He was found sitting at home, confused. His grandson visited him multiple times in the hospital and stayed continuously in touch with all the healthcare providers. The patient was not improving and he had a living will, that specifically noted he did not want heroic measures, no artificial life support as well. After discussion with multiple healthcare providers and the grandson, the patient was transitioned to hospice care.
Each time, I take care of a patient that is above 80 years old, they automatically become my grandparents. My heart softens a tad more automatically. Wonders if they have grandkids. Wonders what kind of a life they have lived so far. A little part of me wonders do they want to continue living the life the condition in they are in if they do not have a living will.
A living will is a written document that outlines an individual's wishes about medical treatments, in case the individual is not in a condition to make their medical decisions. One of the many lessons that we learned and appreciated from our grandfather, about human life is mortal. He had written his own living will and edited it multiple times. Granted he had a law background, so that would help. But he had explicitly discussed his wishes multiple times with his children.
Our grandfather was 83 when we lost him in December 2013. We grew up in India with our grandparents at home, contributing to our upbringing. We naturally were close to them, as they were part of our formal education, but also social education. My grandfather was a very well read man, from science to religion or combining science and religion.
My grandfather did outline in his living will, that he did not wish for artificial life support, including for his nutrition. He said he had lived a wonderful life, with getting to be a great-grandfather, watching his family thrive and prosper, many friendships that he had encountered, and the lives he had the opportunity to mold. That life was full of many battles he had fought, won many and lost just as many.
Outlining your wishes and accepting we are mortal, is another huge step we as humans have to learn to embrace. May it be from the science perspective realizing that our telomeres are aging with each replication, or from religion standpoint that each life has a purpose, and when the purpose is fulfilled, it is time to move to the next purposeful project, which may not be part of this lifetime.
As a physician, we encounter on daily basis, cases where patients had discussed their wishes or patients that had not discussed. Discussing one's wishes to their loved ones takes a huge burden off the shoulders of the person making that decision for you when you cannot. As a healthcare provider, we will continue to treat you, until medicine permits. But medicine and science have limitations, unfortunately. And not every treatment that medicine offers will necessarily give you the life back where you will be able to walk out of the hospital, or even communicate with your loved one again.
So making it even more essential for each one of us to discuss our wishes. One of the cases I remember as a resident in ICU, the patient had end-stage COPD, and could not be removed from the artificial life support that was assisting her to breathe. She would require to remain the rest of her life on the artificial support in a nursing home. She was still able to make rational decisions. She asked if she would be able to eat eclairs ever and go swimming. With her lung function, she would never be able to do so, and she said she did not want to live a life without eclairs or being able to swim.
We each have our own priorities, and goals. Let us all take the moment and discuss with our families, even if it is at the age of 20. The goals and priorities from life at 20 may be different at the age of 30 or 80.
A few good books to read: Being mortal, When breath becomes air.
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