God’s Guidance
Yesterday, I had a tough day. I saw a patient who is close to the end. This is a relatively normal part of my day, and as a general rule, I embrace the moment to help the family face and discuss the reality/practicality/inevitability and the sadness, loss, gravity, and intenseness of the moment. But yesterday, I hesitated and held back. The family was facing a crises and needed someone to be courageous enough to have an honest discussion about goals and where this is all going. In my assessment of this patient, every instinct I had screamed, ‘tell the truth’, which is generally so easy for me. Still, I hesitated because of the back-story. Last week, the patient and his spouse lost their very young adult son suddenly while my patient was hospitalized. I knew that I should do what was needed, but more desperately wanted to protect this amazing wife and mother of any further burden and tragedy. So, I hesitated in following through with my usual advocacy to prevent this family from going through the trauma of a hospitalized end. I still went forward with some of my do-diligence. I had the “goals of care” conversation and talked about what should happen if I were to come in and find the patient without a pulse and not breathing. I always ask, very gently but bluntly, what would you want me to do. Generally, I find that this scenario makes the concept of “code status” very personal and real, more “in the moment”, and for most of my patients, a time of enlightenment. My patient’s wonderful wife said to me “I call the shots, and I want him brought back”. I really try to be respectful and meet people where they are, but honestly, most days, I do push back a little to ask, “to what end?”. So many people have no idea the toll CPR and intubation (being placed on a ventilator, which is an absolute consequence of CPR )take on a terminally ill person. A “code” which is a combination of CPR/defibrillator, cardiac medications, and a ventilator causes trauma, extended suffering, invasive, painful procedures, and result in difficult decisions the family need to make during a high stress crises. And most of the time, the end result is tragic.
But, this day, my instincts failed me, I didn’t want to push the envelope in an effort to protect this vulnerable family, who have cared so lovingly for husband and father. I reasoned (to myself) that I would push a little harder at the next visit.
Then, I was propelled by a divine intervention, the patient’s son. The people in the home during my initial visit were the patient, his spouse and the patient’s grown son. This son has been incredibly supportive through the patient’s journey, and has been devastatingly effected by his brother’s sudden death. Yet, he was able to muster the courage to challenge his mother during our Goals of Care conversation. When his mom said that she wanted everything done, this son said what I would normally say , which is “to what end?” I was amazed and incredibly grateful! Again, my instinct was still to protect this very vulnerable woman, but I did realize that I was being given another opportunity for healing, spirituality, and peace, so I continued the intense conversation that needed to be had for the most dignified end of life scenarios. Thanks to the intervention of this wonderful couple’s son, my patient will be more likely to experience a peaceful end, surrounded by his family, feeling loved and supported. His wife agreed that no end of life interventions would be needed and that she would be willing to let natural death occur when the time comes.
I am humbled by what transpired in this home, and it had nothing to do with me. This son stood up for the dignity of his father, and thanks to his courage, his father will have less suffering and more peace. What an incredible example of God’s guidance in our lives!