L J Idol Exhibit A Week 9 Vital Organs
My name in Eleanor Eaton and in early June, just after the semester ended, my dear old friend Professor Clayton Dawson had a heart attack and was admitted to the hospital. We’d been colleagues for years at the University. We’d had no romantic involvement but were the very best of friends; so I rushed to be by his side. He managed to tell the staff that he wanted me to be involved in his treatment.
Following stabilization in the ER, the cardiologist, Dr. Mitchell, assessed my friend’s condition and recommended a cardiac catheterization, a diagnostic surgical procedure that permits the physician to see exactly which blood vessels are blocked in the heart. Clayton reluctantly agreed to the test but with a tear in his eye, he whispered to me that he was terribly worried about Topaz. “I know you’ll think I’m a foolish old man, but you know that cat means the world to me. “
Clayton had never married, pursuing academia with vigor and vitality. Teaching was his life and his feline companion Topaz was the one who greeted him at the door each evening. She had been ‘his girl’ for the last ten years or so.
“Eleanor, promise me, if I…if they think I’m going to die, please don't let them make me die here. I need to go home and be with Topaz." Then almost as an afterthought, he added, “maybe you’d better call my brother.”
During the catheterization, though, Clayton suffered still another, more massive, heart attack. The surgical team stopped the procedure and, still with Clayton’s consent, but perhaps under duress, to say the least, performed a double bypass and admitted him to the Cardiac Intensive Care Unit (CICU) to recover.
During the surgery, I’d telephoned Brian, Clayton’s estranged younger brother, and brought him up to speed on the situation. Brian had a wife and family and lived in another state. The two brothers hadn’t really communicated that much since their own parents had passed away, several years earlier. I never knew the details of their falling out but I hoped that they might find some resolution and forgiveness before it was too late.
Brian seemed shocked to hear the news but was receptive and indicated that he was concerned and, of course, would catch the next plane to come and support his brother.
Brian was Clayton’s only relative. Clayton had signed a standardized form giving his brother durable power of attorney for his health care many years earlier. The form allowed Brian to make care, custody, and medical treatment decisions for Clayton in the event that he should become unable to participate in his own medical treatment decisions. It also directed that Clayton’s’ life would not be prolonged by lifesaving measures if his condition was determined to be terminal and incurable or if he should be diagnosed as being in a persistent vegetative state.
While Clayton was healing in the CICU, the visiting time was very limited. I made myself scarce so the men could share some quality time. I really hoped they’d patch up whatever differences they had.
Dr. Mitchell and his team were constantly reassessing Clayton and I filled my worrisome hours between brief visits at the hospital and caring for Topaz at Clayton’s apartment. Cats are so perceptive. I knew that she knew that something was wrong but I did my best to reassure her that her favorite man was getting better every day and wanted to be back home with her very soon. The first few days she was withdrawn and didn’t eat much but eventually, she cozied up to me and even climbed into my lap. She was certainly a solace to me during that time.
By mid-June, the doctor admitted that Clayton’s heart was performing below a normal function. He was drifting in and out of consciousness due to some of the drugs he was on. His condition was putting a great deal of stress on his kidneys, which also started to fail. By the third week of June, just as his kidneys started responding to treatment, his lungs succumbed to pneumonia and antibiotics were started.
But on July 1st, he had serious difficulty breathing and had to be put onto a respirator for a 72-hour period to be stabilized. At the end of that time he failed a lung function test.
With that news, Brian decided that his brother should be taken off the respirator and allowed to die.
At the bedside, Brian said to me. “I’m going to tell the doc to pull the plug. I think they’ve done all they can and I don’t want Clayton to suffer.”
Clayton was semi-conscious but made no response. My heart was breaking but I had no legal authority. My purpose there was to lend my love and support but I couldn’t shake Clayton’s request to me about his wanting to be home with Topaz. I was in a quandary about whether I should bring it up.
Dr. Mitchell arrived for rounds and took us aside into the conference room.
“I know you feel hopeless but I do have to offer these options. I disagree with your decision, Brian. Clayton isn’t dying. His kidneys are doing better. In fact, his urinary output is back to normal. The pneumonia is clearing up, too, so there is no question of multiple organ failure. Besides, Clayton did consent to the bypass surgery, which is a lifesaving measure, so he might want other lifesaving measures as well. I would like to suggest that a tracheotomy be done so that his breathing will be more comfortable. I also want to insert a feeding tube. We can also eliminate the drugs that are keeping him in a stupor. We can wake him up and let him tell us what he wants the treatment team to do.
He left us to consider his options. We went back to the bedside and sat down.
I thought Dr. Mitchell made valid points. It did seem like the best way to resolve this conundrum would be for Clayton to be able to tell us himself. After all, it's his life: he's the one who has to lead it or let it go. Right? I jumped at the chance to try to convince Brian that the doctor was right.
“We’ll never know what he might have chosen for himself. Who are we to take away the chance that he might regain his autonomy? And besides, he told me he needs to be with Topaz!” I finally blurted out.
In our current culture of some highly medicalized, drawn out, end-of-life care, life can be an ordeal of suffering, invasive treatments, and loneliness. One’s quality of life diminishes and death can be a welcome respite.
Brian was tortured with thoughts of his brother waking up and consenting to further treatment and then improving just enough to end up spending the rest of his life debilitated and in a nursing home. He had seen his parents that way and couldn’t face the possibility of that fate for his brother.
Brian sighed. “I’d rather spare him that agony. I think it might be better to let him die now. He was of sound mind when he made his living will. There was no question what he wanted and didn’t want then. He’s not a young man anymore. I sincerely believe he would want me to continue to respect his wishes.”
Just then, Clayton moaned a little and we looked toward him. He did his best to open his sleepy eyes. Brian took his hand and leaned in close.” Do you want this to go on, Clayton? Let me know what to do.” Clayton touched the breathing tube and closed his eyes. His lips formed a big NO even though no word came out.
Then he opened his eyes and looked at me. He lifted his hands and made his fingers form a letter T. “What is that?” Brian asked. “He wants a time-out? Do you think it’s the drugs? Should I call the nurse?”
“No, Brian, wait. I think he’s asking for Topaz! “
We were able to make arrangements for Topaz to come visit. Brian declined further extreme measures on behalf of his brother. The respirator was discontinued and Clayton was kept comfortable with medication with Topaz curled gently in the crook of his arm until his spirit slipped away.
Topaz lives with me now and Brian and I keep in touch. We all still miss Clayton.
I was doing some research on the issue of organ donation recently and found a study published in the January 2010 issue of the Journal of the National Medical Association that said about 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients. There was never any discussion in Clayton’s case either way. I often wonder if there was not a missed opportunity there somewhere.
Apparently, doctors have said that they don't care to bring up the subject very often, because it makes patients nervous and uncomfortable. Since many patients are already dealing with difficult problems when visiting their physician, doctors say they don't want to throw another tough topic into the mix.
Patients don’t often like to initiate a discussion about Advanced Directives (ADs) in general either. However, when push comes to shove, they do seem to trust their families and their doctors to give them the best advice. I hope anyone reading this story takes responsibility for educating themselves and others on the importance of discussing and defining their preferences for end-of-life care.
Following stabilization in the ER, the cardiologist, Dr. Mitchell, assessed my friend’s condition and recommended a cardiac catheterization, a diagnostic surgical procedure that permits the physician to see exactly which blood vessels are blocked in the heart. Clayton reluctantly agreed to the test but with a tear in his eye, he whispered to me that he was terribly worried about Topaz. “I know you’ll think I’m a foolish old man, but you know that cat means the world to me. “
Clayton had never married, pursuing academia with vigor and vitality. Teaching was his life and his feline companion Topaz was the one who greeted him at the door each evening. She had been ‘his girl’ for the last ten years or so.
“Eleanor, promise me, if I…if they think I’m going to die, please don't let them make me die here. I need to go home and be with Topaz." Then almost as an afterthought, he added, “maybe you’d better call my brother.”
During the catheterization, though, Clayton suffered still another, more massive, heart attack. The surgical team stopped the procedure and, still with Clayton’s consent, but perhaps under duress, to say the least, performed a double bypass and admitted him to the Cardiac Intensive Care Unit (CICU) to recover.
During the surgery, I’d telephoned Brian, Clayton’s estranged younger brother, and brought him up to speed on the situation. Brian had a wife and family and lived in another state. The two brothers hadn’t really communicated that much since their own parents had passed away, several years earlier. I never knew the details of their falling out but I hoped that they might find some resolution and forgiveness before it was too late.
Brian seemed shocked to hear the news but was receptive and indicated that he was concerned and, of course, would catch the next plane to come and support his brother.
Brian was Clayton’s only relative. Clayton had signed a standardized form giving his brother durable power of attorney for his health care many years earlier. The form allowed Brian to make care, custody, and medical treatment decisions for Clayton in the event that he should become unable to participate in his own medical treatment decisions. It also directed that Clayton’s’ life would not be prolonged by lifesaving measures if his condition was determined to be terminal and incurable or if he should be diagnosed as being in a persistent vegetative state.
While Clayton was healing in the CICU, the visiting time was very limited. I made myself scarce so the men could share some quality time. I really hoped they’d patch up whatever differences they had.
Dr. Mitchell and his team were constantly reassessing Clayton and I filled my worrisome hours between brief visits at the hospital and caring for Topaz at Clayton’s apartment. Cats are so perceptive. I knew that she knew that something was wrong but I did my best to reassure her that her favorite man was getting better every day and wanted to be back home with her very soon. The first few days she was withdrawn and didn’t eat much but eventually, she cozied up to me and even climbed into my lap. She was certainly a solace to me during that time.
By mid-June, the doctor admitted that Clayton’s heart was performing below a normal function. He was drifting in and out of consciousness due to some of the drugs he was on. His condition was putting a great deal of stress on his kidneys, which also started to fail. By the third week of June, just as his kidneys started responding to treatment, his lungs succumbed to pneumonia and antibiotics were started.
But on July 1st, he had serious difficulty breathing and had to be put onto a respirator for a 72-hour period to be stabilized. At the end of that time he failed a lung function test.
With that news, Brian decided that his brother should be taken off the respirator and allowed to die.
At the bedside, Brian said to me. “I’m going to tell the doc to pull the plug. I think they’ve done all they can and I don’t want Clayton to suffer.”
Clayton was semi-conscious but made no response. My heart was breaking but I had no legal authority. My purpose there was to lend my love and support but I couldn’t shake Clayton’s request to me about his wanting to be home with Topaz. I was in a quandary about whether I should bring it up.
Dr. Mitchell arrived for rounds and took us aside into the conference room.
“I know you feel hopeless but I do have to offer these options. I disagree with your decision, Brian. Clayton isn’t dying. His kidneys are doing better. In fact, his urinary output is back to normal. The pneumonia is clearing up, too, so there is no question of multiple organ failure. Besides, Clayton did consent to the bypass surgery, which is a lifesaving measure, so he might want other lifesaving measures as well. I would like to suggest that a tracheotomy be done so that his breathing will be more comfortable. I also want to insert a feeding tube. We can also eliminate the drugs that are keeping him in a stupor. We can wake him up and let him tell us what he wants the treatment team to do.
He left us to consider his options. We went back to the bedside and sat down.
I thought Dr. Mitchell made valid points. It did seem like the best way to resolve this conundrum would be for Clayton to be able to tell us himself. After all, it's his life: he's the one who has to lead it or let it go. Right? I jumped at the chance to try to convince Brian that the doctor was right.
“We’ll never know what he might have chosen for himself. Who are we to take away the chance that he might regain his autonomy? And besides, he told me he needs to be with Topaz!” I finally blurted out.
In our current culture of some highly medicalized, drawn out, end-of-life care, life can be an ordeal of suffering, invasive treatments, and loneliness. One’s quality of life diminishes and death can be a welcome respite.
Brian was tortured with thoughts of his brother waking up and consenting to further treatment and then improving just enough to end up spending the rest of his life debilitated and in a nursing home. He had seen his parents that way and couldn’t face the possibility of that fate for his brother.
Brian sighed. “I’d rather spare him that agony. I think it might be better to let him die now. He was of sound mind when he made his living will. There was no question what he wanted and didn’t want then. He’s not a young man anymore. I sincerely believe he would want me to continue to respect his wishes.”
Just then, Clayton moaned a little and we looked toward him. He did his best to open his sleepy eyes. Brian took his hand and leaned in close.” Do you want this to go on, Clayton? Let me know what to do.” Clayton touched the breathing tube and closed his eyes. His lips formed a big NO even though no word came out.
Then he opened his eyes and looked at me. He lifted his hands and made his fingers form a letter T. “What is that?” Brian asked. “He wants a time-out? Do you think it’s the drugs? Should I call the nurse?”
“No, Brian, wait. I think he’s asking for Topaz! “
We were able to make arrangements for Topaz to come visit. Brian declined further extreme measures on behalf of his brother. The respirator was discontinued and Clayton was kept comfortable with medication with Topaz curled gently in the crook of his arm until his spirit slipped away.
Topaz lives with me now and Brian and I keep in touch. We all still miss Clayton.
I was doing some research on the issue of organ donation recently and found a study published in the January 2010 issue of the Journal of the National Medical Association that said about 65% of physicians surveyed agreed that organ donation discussions were within the scope of their medical practice, but only 4% reported having discussed the subject with their patients. There was never any discussion in Clayton’s case either way. I often wonder if there was not a missed opportunity there somewhere.
Apparently, doctors have said that they don't care to bring up the subject very often, because it makes patients nervous and uncomfortable. Since many patients are already dealing with difficult problems when visiting their physician, doctors say they don't want to throw another tough topic into the mix.
Patients don’t often like to initiate a discussion about Advanced Directives (ADs) in general either. However, when push comes to shove, they do seem to trust their families and their doctors to give them the best advice. I hope anyone reading this story takes responsibility for educating themselves and others on the importance of discussing and defining their preferences for end-of-life care.