Wednesday, August 29, 2007

Death and Dying in the Hospital

Sorry for the recent spotty postings.

This blog has been a way to jot down the meaningful experiences of life, things that I don't want to forget. It's randomly interspersed with interesting factoids that come up along the way. I'm always amazed (and touched) that people stop by to read some of the posts. For those frequent visitors, thanks for coming back. I hope you like what you read.

Part of the reason for the recent lack of posts, is that I've been trying to process some of the hospital cases we've seen. For whatever reason, we've had a number of very sad cases this month. People actively dying before our eyes.

People dying isn't new. We see it in med school. We see it in internship. Others see it daily in residency. But the derm world is usually a little more removed from the acutely ill, inpatient scenario.

And I've never been terribly bothered by seeing sick or dying patients. Of course, there are those patients that we will never forget, and whose death shakes us to the core. But it would be hard to work in our field if every illness and every death rendered us emotionally vulnerable.

Life, after all, must go on.

But we've just had a series of patients that have made me ponder about life. Maybe it's a function of getting older. Some of these patients are my parents age. Some are young enough to be my children. Some, are my age, or just a few years younger. Or maybe it's because I'm not used to seeing such sick patients day after day. I don't know.

Here's a few of the patients we've had:
A baby, born deformed, rejected by his parents, who dies without reaching his one month birthday.
A teenage boy who is perfectly normal until he collapses one day and is found to have a severe congenital problem that cannot be fixed.
A mother of five who had a simple elective procedure done, which led to a series of unexpected complications, which led to a transplant, which led to graft versus host disease, who dies.
An infant with a rare genetic condition who gets a bone marrow transplant, develops complications from the transplant, and is actively dying before our eyes.

How has the institution of the "hospital" evolved over the decades? The prior generation brags about how patients stayed in the hospital for weeks on end. Many of these patients would be today considered the walking well and not admittable. But as hospital admissions are harder to come by, especially at a tertiary care teaching institutions, hospital wards seem to be filled with death and dying.

Now, there's nothing wrong with death and dying, if it's done well. I'm a huge fan of well coordinated hospice facilities. But death and dying in the usual hospital way, with tubes and lines out of every orifice, rib-crushing chest compressions, veins pumped full of powerful medications, in a scenario all too often colored by the unwillingness by all involved to accept what was long coming, is not the way to go.

But what can you do?

Things often don't go wrong all at once. First the blood pressure is unstable. The the respiratory system is down. Before you know it, due to the miraculous, potentially life-saving advances that we have, the person has already slid to a place where they are dependent on life support. And once you start such interventions, what family member can truly look at their loved one, and decide to withdraw support? Even in the face of no hope of success, how can we even ask that of them? Because, at the end of the day, hope is a beautiful thing. And for those who withdraw support, who will they turn to if feelings of inadequacy or guilt arise?

Or what about the poor families who leave their loved ones to maybe grab a quick bite to eat? How do you explain to the daughter that, even though her mother has been obviously sick for a long time, she is now gone?

It's made me really think about how unfair life can be. How some people can be born and spend their entire lives blissfully unaware of how unfortunate the unfortunate can get, while others are born, suffer, and leave the world in a miserable state. Or how we each take our lives, our health, no matter how incomplete, for granted. Even if we are sick, we are not as sick as some others. As a wise man once said, "if you cannot be grateful for what you have, then at least be thankful for what you have been spared."

It's made me think about how lucky we are to have an uneventful day. That most of us are so very lucky to not be on the receiving end of a phone call starting with "I'm Dr. XXX calling from Big University Hospital regarding your father/ mother/ loved one." That our bodies are truly amazing things that keep on working no matter how we abuse it. That we shouldn't forget to tell loved ones how we feel, because tomorrow should never be taken for granted. And that we should truly seize the moment, live and love well, and be very grateful for what we have, because nothing - NOTHING - is guaranteed.

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Tuesday, August 28, 2007


Henrik Ehrsson of University College London's Institute of Neurology reports being able to recreate the sensation of "out of body experiences."

Apparently, if you use virtual reality goggles connected to a 3-D camera pointed at the back of your head, you get the feeling of looking at "yourself." When these are combined with other sensory stimuli (rubbing your chest, hammer swinging toward your camera "eyes"), the sensation of watching yourself becomes more real.

It makes sense. Kind of like why people get scared watching a horror flick. Or cry with the hero/heroine in a drama. All our experiences are some combination of what is truly happening, the phyical vantage point from which we see the situation, our mental interpretation of the event, and later, our retrieved memories of the event. It begs the question - if the mind can be fooled into believing that illusions are real, how much of "reality," our lives, our trials and tribulations, is but a tangled mess of complex illusions?

On a more positive note, it inspires us to believe that just as the mind can be tricked, so it must have the potential to break free from illusions, and see things as they truly are. That perhaps we can stop actively contributing to the illusion long enough to see that the sensory organs and the mind, our interpretation of the world, lie somewhere along the spectrum of interpretation and illusion. That perhaps the things that we value as a society, things that people spend their lifetimes working towards, are but illusory products of misinterpreted illusions. If people were able to truly see and understand just some of this, the world would be a better place.


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Thursday, August 23, 2007

Wisdom of the Day

At the time, I searched desperately inside myself, for any memory of happiness. Now, fifty years later, I've learned... I was part of someone else's happiness.

What a wonderful discovery.

I only came to this discovery through the time I spent here, through all the people I met and said goodbye to here.

You too, someday, will find this.

- Mochizuki, After Life
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