The Brain-Alive Heart-Dead.

(c) Dr. Rajas Deshpande

“We don’t want her to suffer. We don’t want any ventilator etc. treatments”.
Said the calm son, no traces of emotional tones in his speech. His mother was admitted last night with stroke.

Quite a sophisticated family, this son owning a company of repute. His teenager daughter was sitting by her grandma in the ICU, patting her unconscious forehead.
“Can she hear us doctor?” the distraught daughter asked.
“Sometimes, only when she is a little more conscious”.. It is difficult for me to be emotionally rude.
“Because I want to talk to her only once more.. to say sorry.. I was sulking after a fight with her when this happened.. I should never have fought with her…” the sweet soul broke down.
Her father tried to calm her.
This is where I received the first shock. His pacifying his own daughter had a formality. It did not suggest “I am proud of your emotional bond with my mother”… It rather suggested “Grow up, you stupid, these things happen”.

As I walked out of the ICU, his wife wished me. “How is Ma, doc?” she asked, accompanied by her brother. I told her the truth: “Fluctuating, but critical still”.
Then the expected question: “How long, doc? We don’t want her to suffer too much”.
“Sorry, can’t say at present”.

If I myself ever had an accident, I want to live. I want my doctor to try the best to make me survive, to give me one more chance to see and touch and hear my dear ones. I want to say sorry to those I may have offended, and also to say proper goodbye to those who love me. I will not want my family to decide whether the doctors should try their best for me or not.

I have asked this very question to some people I have faith in the sanity of. The answer rarely was “Don’t save me if it took a lot of effort”. Some classified further: “If I was to remain in a vegetative state permanently, then alone let go”.

Most of my old / very old patients explicitly state that they want to live as much as they can, with as much health that they can get. Nobody except the depressed / frustrated actually say that they want to die, a statement in itself contradictory to their being in the hospital.

I have had differences with some colleagues who “Let Go” and encourage the willing family to make the same decision. It is useless, they argue, to spend so much and try for such a small possibility of meaningful survival. Patient must be able to choose dying with dignity, they advocate.

Many of my colleagues differ like myself, and for a reason: if the patient has expressed a wish prior in complete senses that he / she wants no resuscitation / effort to be made for their survival, then a doctor must respect that. But I think NO one else can make that decision on behalf of the patient after they have lost senses. An unconscious patient is still alive until he / she is brain dead, and it automatically becomes a duty of the doctor to make all efforts to try for the best outcome.

There are many sweet excuses people quote, including suffering, dignity, torture, tubes, pain etc. to justify “letting the patient die”. The real reasons often are: expenses, time, hard work, stress, uncertainty associated with an elderly being ill and the perceived “uselessness” of a debilitated / old / disabled person in the family, adding to the future bills. Elderly do not even have emotional value in many families now.

We are in a world where people have learnt the tact of carrying out entire discussion hypocritically, knowing that both are actually lying, but still pretending to understand each other. Such discussions decide the fates of hundreds of unfortunate old and unconscious patients who then become victims of “Lacklove” decisions made by the very people they gave birth to and grew up!

Expenses can be reduced by offering care in smaller nursing homes / govt. hospitals. The decision of whether the patient will live or not should not be open to discussion about patients who have NOT written a will against their own treatment. If the patient is “Brain-Alive”, treatment must continue. For no team of Neurologists / experts in the world will guarantee the outcome on the bad side: there are always chances of regaining meaningful consciousness in every patient who is not brain dead. And we the living who attempt every day taking whatever tiny chances we get to survive, to grope more and more of life we can should be the last people to say “Let Go” when it comes to someone else’s life. It would morally amount to a murder.

“We hear some doctors keep dead bodies on ventilator in the ICU just to extract more money” said one “business minded” friend to me once. We doctors are trained against violence as it hurts the very human body we are meant to guard. So I answered him verbally only: “With all hospitals almost running full, critical patients in waiting areas why would any hospital keep on ventilating the dead?”.

There are monitors, files, paperwork, and many doctors, nurses, other staff in each critical care unit: how can people imagine that the dead will be kept on machines in such units? Or is it just another social trick to mask the mirror of reality? A small question: If the hospitals start declaring who all chose to “SHUT DOWN” life support systems upon their own relatives / parents, took such critical patients home, admitted them late beyond life-saving period, will the society be happy about it? Then why make such gruesome allegations against a whole profession who even bring some dead back with immense effort, without even knowing them? Why do you think thousands of “Code Blue” teams run without caring for their own life when someone is dying, anywhere in the world?

God knows how many doctors pay patient’s bills, especially in emergency. So many doctors start the treatment in corporate hospitals, accepting the responsibility for patient’s bills as relatives come unprepared (no corporate hospitals move without advance or insurance except in emergency).
There are also many relatives who don’t sleep, don’t even eat till their patient regains consciousness. There are many who silently suffer with the patient. Many sell their belongings to pay hospital bills and still tell the doctor “Try your best doctorsaab, don’t worry about anything. I will pay every bill”. These, unfortunately, are the illiterate, poor, rural and real human beings.
These two: the doctors and relatives who try to save the critical, especially old patient desperately are both being classified under “Impractical, Stupid” people gradually.

Because our society has matured to money.

As I met the patient next day, still in the twilight zone between life and death, there was no one with her except the granddaughter with swollen eyes. She exclaimed, smiling through her tears: “Doc, she opened her eyes and looked at me for a few seconds… She didn’t say anything, but I knew she recognised me and she was happy to see me.. I know her eyes.. she was awake in that moment” and she broke into sobs.

Mercy in the skies often comes alive only with love.
The patient regained her senses in a week.
As she asked for discharge, holding her grand-daughter’s hand, she looked at her son standing by, and proudly told me “Doc, this is my son.. He owns the XYZ company.. He takes very good care of me”’

Avoiding eye contact with anyone, he hugged his mother and said “I love you Ma”.

His teenage daughter kept staring at the floor. I looked at her face.

I don’t wish to see that extremely scary expression again.

© Dr. Rajas Deshpande

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