Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.See all posts »
Discussing End of Life
The call often comes in the middle of the night, and usually goes something like this: “Doctor, we have a 67 year male who was found down at home. CPR has been in progress for 45 minutes, and he’s been shocked five times. We finally have a pulse and a blood pressure, but barely. He’s on the ventilator, and remains unresponsive. We need your help.”
I arrive in the emergency room to find a pale and clammy man on a breathing machine, connected to at least four different intravenous drips which are helping to stabilize his heart rhythm, and keep his blood pressure in a range high enough to keep blood flowing to his brain. His family is frantic. Typically the patient has not seen a physician in years, and has never discussed his wishes regarding resuscitation and end-of-life care. In this situation, we in the medical profession are usually obligated to “do everything” until the family is able to come to a decision.
In some cases, the patient will rally and recover sufficiently to ultimately leave the hospital. If effective CPR was started at home, and the paramedics were called promptly, the chances of recovery may be quite good. In that case, we’ll usually see signs of improvement within the first 48 hours. But many times our patient was unconscious and without sufficient blood flow long enough that the likelihood of meaningful recovery is dismal. This is when things can get very difficult.
At the time of such a calamitous event, the family and other loved ones often find it hard to think clearly. They may also feel overwhelmed by the idea of having to make a decision about when and whether to withdraw care. Religious, ethnic, and social beliefs and concerns frequently come into play.
All of these issues are nuanced and complex, and to have such a burden placed on a grieving and frightened family often seems cruel. Yet we physicians, nurses, respiratory therapists, and other medical professionals want to do what is best and right for the individual.
Death is a part of life, and a living will can make all the difference, relieving others of the terrible responsibility of decision making when aggressive medical care seems futile. (Of course, we are not talking about euthanasia.) For some, doing “everything” is the right thing, yet for many, a peaceful and natural death is the kindest form of “everything” we can offer. Having a discussion with your family and physician, and keeping a living will on file, will assure that your wishes are respected at the end of your life.
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