I’m currently seeing patients in rooms 6, 8 and 10 on one hospital floor. Rooms 6 and 10 are interesting because both patients have similar problems, but totally different ways of approaching them. Actually, the two cases are very different medically. But the projected course and endpoints are very similar: suffering for an unpredictable length of time – anywhere from a few days to a few weeks – and then death. Both patients are elderly, having lived good, full, rich lives…but the end is now near.
In moving between rooms multiple times through the night, I’ve designated room 6 the “football” room, and 10 is the “karate” room. Here’s why:
Patient #6 wants to fight her disease every step of the way. EVERY step. She wants full CPR if she stops breathing, even though the likelihood of success is around 1% while the probability of a poor outcome – like a broken sternum and/or brain damage – is around 60-80%. She is getting tube feedings and IV feedings too. She does not want to be comfortable…she wants to fight. The sounds of the football field of medicine ring from this room: oxygen hydrators, infusion pumps, nebulizers and the chattering T.V….the sounds of life and conflict. One team has a huge lead in the 4th quarter – we all know who is going to win – but the losing team doggedly lines up play after play, hoping for the best. The football room is boisterous, clamorous and (medically, at least) some version of violent. The room is a clenched fist of rebellion and will.
Four doors down is Patient #10. This is the karate room. You will find serenity and focus here. No bubbling, no beeping, no chattering. Her husband maintains a constant vigil to make sure she is not in pain. At the slightest quiver of her brow, he jumps up and presses the PCA (patient-controlled analgesic) machine to give her narcotics. He last did this at 4am, since he was wide awake and monitoring any sign of pain she might exhibit. She is on a constant narcotic medications to keep her in a state of semi-consciousness, which protects her from the worst of what would be literally inhuman levels of pain. By day, other members of her family surround her, softly whispering their salutations and goodbyes. An aura of sadness and stoicism flows from this room. Unlike the fist of battle rage in room 6, the karate room is an open hand of acceptance, and the peace that surely follows it. In room #10, I constantly know the dignity of this human life as it ends before my eyes.
I grew up watching football. Still love my Denver Broncos (C’mon, donkeys, get an O-line!). I love the clashing and bashing…the sheer conflict of it. So, there is a part of the approach in room 6 that inspires me. Sometimes, I think, I want to go out like that; fighting tooth and nail ’till the very end. When I get there, I’ll be muddy, sopping wet and beat to hell. But so too (hopefully) will my opponent to some degree.
By contrast, I don’t know anything about karate…except some stuff I learned from watching “Karate Kid” in Jr. High about how if you get it right, you can chop beer bottles in half with your bare hand. So, I suppose I should be more inclined to agree with the approach in room 6. But I’m surprised to realize that in fact I hope to go out like the lady in room 10. I’d rather die dignified and comfortable than covered with mud and blood. There’s something about accepting fate in this approach that I find appealing…and right.
While living in Israel, I found that western-trained doctors (as Israeli doctors are) were frequently annoyed when they cared for Arab patients with terminal diseases, especially the more traditional ones. Many Muslims are quick to assent to fate; they believe they are in the hands of Allah and take peace in this. They often are lackadaisical about fighting their disease with allopathic medicine. As a Christian, I think this is a lesson we need to learn better from our Arab half-brothers. If we REALLY believe we are going to a better place, why fight so hard against death? Christians are supposed to be free from death. Why do we fear it so much?
Aside from spiritual issues, it does not escape me that patient 6 is forcing the rest of us to pay for the extremely expensive care that will negligibly prolong her life. Neither the patient nor the family can in any way afford the extraordinary care that is currently demanded. Suddenly, the battle in that room seems craven and virulent. The strategy went from a romantic frontier ideal of manifest destiny to wanton coercion of the group collective forced to uselessly give care.
So, when my day arrives to hear the doctor say, “Hmmmm, this doesn’t look good,” (assuming some high-speed, fate-tempting endeavor doesn’t do me in first), I hope I have the presence of mind to tell my family, “Please, just give me the karate room.”