“Well, Dr. Death here would like to just smother her with a pillow…”
The residents on service with me all shifted in their seats uncomfortably, glancing up to see how I was going to take the taunt.
What had I done?
I hadn’t punctured a lung during a central line placement. I hadn’t given the wrong medication. I most definitely hadn’t smothered her with a pillow.
I asked most of my patients about their end of life wishes and defended those wishes vigorously. I worked hard to make sure dying patients didn’t suffer… Morphine nebulizer treatments for shortness of breath, benzodiazepines liberally for anxiety, heck I did whatever it took. And if you wanted to be “full code” well I could do chest compressions until rigor mortis set in if that was what you wanted.
The main thing, though, was that I just talked to people about dying.
It is a subject, frankly, that makes a lot of physicians uncomfortable. We are trained to try to save lives and as such we forget that death is as much a part of living as life itself.
So why am I even bringing this up? Because of the young woman with a terribly aggressive brain cancer who wants to kill herself. The Urban Doctor Mom wrote a great post yesterday about this, you can read it here: First Do No Harm..
Yesterday I thought I knew the answer.
Now, I am not sure.
I might actually choose to end my life if I were looking down the barrel of that gun. I am certain that someone else should not make that decision for me. It might not be the right decision for everyone but I sure think the freedom to choose is an important right.
There is a time to quit. Sometimes we forget that.
I have had patients with severe strokes in vegetative states get feeding tubes placed because no one had the balls to step up and tell the family that it is more humane to not do it. My family knows that under no circumstances should I be intubated (aside from surgery) or have a permanent feeding tube placed.
Watching your body stop working is terrifying. Heck, having to wear my “old lady glasses” to trim my kiddo’s finger nails was a huge emotional blow. I cannot even imagine what it would be like to lose bladder/bowel control, the ability to walk or feed myself, or to no longer have the ability to understand or form new memories.
That being said, I am not sure that as a physician I would be comfortable playing a role in ending someone’s life. I can give morphine to treat pain which might hasten death but I am treating the pain, not trying to kill. It is an important distinction.
Ultimately, we all just want a happy ending, even though what that means is as diverse as living.