free to be

oh my. where to begin...

a little debriefing inside my head.

We have a patient who is sustained by a ventilator. I wrote about him before. It was understood at the time of admission that when his disease progressed to a place where he could no longer communicate by blinking his eyes, the ventilator would be turned off...his wishes, of course. Never before have we had a patient who is perfectly coherent but ventilator dependent so this is all new territory for me and for our team as I know it. I really, really like this man and it's been a little much to try and process. This week however, it's become real--decisions are being made and this is no longer abstract thoughts we can push away for some distant time. And unfortunately, it's not some lifeless body we're talking about. There's a man in there who is funny and intelligent and strong.

He's tired. He blinks to tell us he wishes to die; not when he can no longer communicate, like he initially had said, but now. What does that mean? That means his team of health care providers are ethically responsible to carry his wishes out.

I haven't really allowed myself to think about this too much because even as I type I feel this gigantic knot in my throat. I can't imagine. It's all so huge and foreign. To stand there and watch his loved ones say goodbye. I can't fathom that kind of grief. It seems the weight of the air in the room would make it impossible to stand or breathe. And what about him? It takes such courage to stay alive-trapped within the most oppressive prison. But wont it take even more courage to die? To tell us for that last and final time that it's okay...that it's time to turn the machine off?

In living rooms and bedrooms all over the tri-cities, people are saying goodbye. But this is not the same. There's nothing about this that is familiar.

To be clear for those of you who are not in the medical field. This is NOT physician assisted suicide. This is a man who would be dead if not for the artificial lungs that mechanically force breath in and out. Just like you and I must decide if we should want life support to sustain us, he made his decision. Initially he chose the ventilator and it has given him more time to be with his family. Now he is competently making a decision as to whether or not the time is right to let his body do what it tried to do a year ago.

I feel like there are so many dimensions to all of this. I could write volumes but this is about all I can stand to think about for today.

So...not the brightest most pleasant blog in the world but it's the most prevalent thing on my heart today. I'll write more soon--
and I promise to keep it light. :)