Love before you lose.

I feel like I should first explain what I have been doing these past few months, because many of my friends haven’t seen me in a while and I have not written any new blog posts recently.  This summer, I was busy studying and taking the first and most important of our three medical licensing exams, the USMLE Step 1.  A mere few days after taking the exam, I started my third year clinical rotations.  I have thought and seen many things over these past couple of months that I have wanted to write about, but I have not had the time.  I usually just ended up discussing those things with friends.

I am currently on a palliative care rotation, which focuses on relieving and preventing the suffering of patients.  I mostly see patients who are at the end of their lives.

Let me share a little story with you (with a few details modified for privacy purposes, of course):

     You are asked to consult on a 72-year-old woman in the ICU who was recently brought to the ER after suffering her second stroke.  She has end-stage dementia and is now unable to speak due to her stroke.  Her two sons are both present with her in the hospital.  As you flip through her chart, you notice that she does not have an advance directive, meaning that she has not specified what she wishes her care to be and who she wants to make health care decisions for her in case she is incapacitated—either physically or mentally.  Her lab values and tests show that it is unlikely that she will live much longer.
     Since she does not have an advance directive and is currently unable to make her own medical decisions, the health care power of attorney (the power to make health care decisions) is now legally with the widowed patient’s adult children.  You decide to bring up the difficult topic of their mother dying and what should be done.
     You explain the situation to her two sons.  One son listens calmly, is quiet for a few minutes, and then states that since their mother is in pain and will not live more than a few days, he wishes that she is kept pain-free, comfortable, and that she passes peacefully.  The other son is angered by this.  He states that there is no way his mother is dying and that everything must be done to keep her alive.  You explain to him that doing some things will only further her suffering without prolonging her life, but he does not listen.
      The two sons argue with each other all night while you are away.  When you return and see this, you decide to take the angrier son aside to your office to have a talk with him.  After about thirty minutes and plenty of tears, the son leaves your office and states that he too now wants his mother to be kept comfortable and free of pain, and that he will sit and pray for her as she passes.

Why was one son unable to accept his mother’s death?  Why did he argue and insist that she was not dying?

When he entered your office, you asked him these questions.  He burst out crying and explained to you that he did not feel like he had done enough for his mother.  While the other son lived with his mother and cared for her, this son lived in another state and hardly saw or spoke to his mother.  He initially felt that if he let her pass away now without doing everything medically possible, even if it meant more pain and suffering for her, he would be ridden with guilt.

Friends, do not let this situation happen to you.

Often times, it is not the patient who has trouble accepting their situation; it is their family members and friends.  I have both experienced this myself and seen this in other patients.  I was fine whenever something happened to  me.  When hit by life, I'm briefly frustrated, and then I do my best to be done with it.  There are some things we just have to accept and realize that we can't change, so we do our best to change everything else that we have the ability to do so.  I have noticed, though, that others cannot let it go.  Sometimes it is family members.  Sometimes it is friends who regret doing or not doing things to/for me.  I feel sorry for them.

We have a tendency to delay things.  We get so caught up in our own lives and our own desires that we push other things and other people aside.  We consider ourselves too important.  We are ungrateful.

Think about all the people who have done so much for us, including our parents, our siblings, our children if we have any, our other family members, our teachers, and our friends.  We cannot let opportunities to reach out to them and be kind pass by us.  We do not want to be left thinking after it is too late that we wish we could have done more for someone when we had the opportunity, but we were too blind to see it.

Love before it’s too late.  Love before you lose.