so maybe it's true that i can't live without you
I'm a huge fan of that song "The Luckiest" by Ben Folds despite semi-creepy lyrics. There's something about its honesty along with a captivating piano melody draws me in. I wanted to comment on a lyric in the song and tell a story or two to go along with it.
next door, there's an old man who lived to his 90's
and one day, passed away in his sleep
and his wife, she stayed for a couple of days and passed away
i'm sorry, i know that's a strange way to tell you that i know we belong
I will share with you my understanding of true love, in the face of end of life. Names have been changed to protect privacy.
1. Anna
On my first week of working at the hospital, my PA preceptor Aaron and I were asked to see a lady in her late 80's who was admitted for observation of vague complaints of chest discomfort. She had a few risk factors for heart attack including high blood pressure, but all testing was coming up negative for any blockages in her heart or cardiac/pulmonary for her chest pain. Everything was coming up normal. At baseline she was somewhat demented - she would definitely engage in conversation with you, but every so often she'd get tangential with things that would not pertain to the topic at hand. She's the best kind of historian if you're going to have one with dementia - someone that will answer your questions appropriately, even if they do go wayward.
As Aaron was talking with her, she began to get tearful as we waded through the questions about her chest pain. She would make reference to "so many losses" which led us down that path, despite making her more upset, of what exactly she was talking about. She would interject with thoughts about her husband.
Aaron asked her daughter how long ago her husband had passed - roughly 10 years. But this lady was still dwelling on it and was so distraught about losing him that she kept living it over and over. Instead of just missing him, she was feeling like she was losing him each day.
It was then that we realized: she didn't have a heart that was broken, but instead she was suffering from a broken heart.
It looked like we were much more dealing with a case of geriatric depression, which is NOT a normal part of aging. This lady could benefit from either pharmacologic therapy or a geriatrician specializing in mood disorders in the eldery. So that's what we set her up with. It broke my own heart to watch her cry, though.
(And just for a little factoid here related to this, but what Anna did not have - there is a form of cardiomyopathy called Takotsubo which is actually a "broken heart" syndrome that you see mostly in middle-aged women suffer from. After events of acute stress/emotional upset, patients can present to the emergency room with an EKG and even cardiac enzymes suggesting a real heart attack, but come to find out, it's not at all related to blockages. An excess release of catecholamines leads to actual ventricular ballooning of the heart, and treatment is only supportive. Interesting, huh?")
2. Helen
Helen was a very sick woman, one you could tell from the moment you walked in the room that she was letting go. She came in essentially for failure to thrive, as she had been throwing up and not eating, not showing interest in getting up, not doing anything at all. She was in end-stage renal disease with a ton of other problems and had to go to dialysis 3 times a week. When you would ask her how she was doing, she'd say "terrible" and "awful" but just didn't have it in her to describe what was going on.
Her daughter was present and really was her only cheerleader. Her daughter would swear up and down that when we weren't in the room, her mom would eat 3 bites instead of 1 of her pudding (which really wasn't that much more, honestly), that she really wanted to do physical therapy but it just "wasn't the right day." Every PT note said something like "Daughter motivated for PT, patient less so." Helen really was giving up before our eyes. She had not been out of bed in a year. Her potential for rehab given her state of health was really pushing it. Yet she was stated as a full code, do everything, be agressive with any therapies you can. And that's what she got, but she continued to just exist without any real big meaning behind it.
Finally Dr. Manzon got in there to have a real heart to heart with Helen and her daughter regarding these heroic measures. Helen admitted she was tired of dialysis and the way that it made her feel - admittedly dialysis makes people feel like complete crap, and most times she would only get an hour into it before she'd be in tears. She said she'd thought about not going through all of this if it was just prolonging things. Dr. Manzon asked her if she knew the consequences if she stopped dialysis - death within a few days, and Helen sounded quite sure of it. If only it were that simple. Not only was her daughter not going to have any of that, Helen had been married for 60+ years and her husband was at home, awaiting her return and telling her to push through it even if it hurt.
I had a conversation one day with Helen on one day when she was particularly responsive to answering questions and apparently her husband and her had met down at a service station and the story with old folks is always the same - "he was interested, I was not" - and at 18 years old she was engaged to be wed and they'd been happy ever since. The secret to marriage, she answered, was "always working at it." She told me randomly that she hated "hearing him cry on the phone."
Heavy. In reality this poor woman was so ready to die, but she was not being allowed to pass away comfortably because of her family's wishes. The word ultimately comes from her, but she couldn't bring herself to say the words "stop dialysis" or "DNR" because she was so afraid of hurting those around her. You can't blame the family necessarily, though -- who wants to let go of their mother or lifelong partner?
But this experience taught me a valuable lesson - someone's life is ultimately their own to live, as well as ownership of their death. This lady was tired of how she was living but felt too guilty to die. An ultimate sacrifice for love? I'd say so.
That leads me into thinking about that song by Boys Like Girls with Taylor Swift, "Two Is Better Than One," where they go, maybe it's true, that I can't live without you. I never put forth much thought to this statement as more than a rhetorical one, but maybe it is more concrete than we think.
The only part that doesn't fit is the line, but there's so much time to figure out the best of my life -- what do you do when this isn't true anymore?
next door, there's an old man who lived to his 90's
and one day, passed away in his sleep
and his wife, she stayed for a couple of days and passed away
i'm sorry, i know that's a strange way to tell you that i know we belong
I will share with you my understanding of true love, in the face of end of life. Names have been changed to protect privacy.
1. Anna
On my first week of working at the hospital, my PA preceptor Aaron and I were asked to see a lady in her late 80's who was admitted for observation of vague complaints of chest discomfort. She had a few risk factors for heart attack including high blood pressure, but all testing was coming up negative for any blockages in her heart or cardiac/pulmonary for her chest pain. Everything was coming up normal. At baseline she was somewhat demented - she would definitely engage in conversation with you, but every so often she'd get tangential with things that would not pertain to the topic at hand. She's the best kind of historian if you're going to have one with dementia - someone that will answer your questions appropriately, even if they do go wayward.
As Aaron was talking with her, she began to get tearful as we waded through the questions about her chest pain. She would make reference to "so many losses" which led us down that path, despite making her more upset, of what exactly she was talking about. She would interject with thoughts about her husband.
Aaron asked her daughter how long ago her husband had passed - roughly 10 years. But this lady was still dwelling on it and was so distraught about losing him that she kept living it over and over. Instead of just missing him, she was feeling like she was losing him each day.
It was then that we realized: she didn't have a heart that was broken, but instead she was suffering from a broken heart.
It looked like we were much more dealing with a case of geriatric depression, which is NOT a normal part of aging. This lady could benefit from either pharmacologic therapy or a geriatrician specializing in mood disorders in the eldery. So that's what we set her up with. It broke my own heart to watch her cry, though.
(And just for a little factoid here related to this, but what Anna did not have - there is a form of cardiomyopathy called Takotsubo which is actually a "broken heart" syndrome that you see mostly in middle-aged women suffer from. After events of acute stress/emotional upset, patients can present to the emergency room with an EKG and even cardiac enzymes suggesting a real heart attack, but come to find out, it's not at all related to blockages. An excess release of catecholamines leads to actual ventricular ballooning of the heart, and treatment is only supportive. Interesting, huh?")
2. Helen
Helen was a very sick woman, one you could tell from the moment you walked in the room that she was letting go. She came in essentially for failure to thrive, as she had been throwing up and not eating, not showing interest in getting up, not doing anything at all. She was in end-stage renal disease with a ton of other problems and had to go to dialysis 3 times a week. When you would ask her how she was doing, she'd say "terrible" and "awful" but just didn't have it in her to describe what was going on.
Her daughter was present and really was her only cheerleader. Her daughter would swear up and down that when we weren't in the room, her mom would eat 3 bites instead of 1 of her pudding (which really wasn't that much more, honestly), that she really wanted to do physical therapy but it just "wasn't the right day." Every PT note said something like "Daughter motivated for PT, patient less so." Helen really was giving up before our eyes. She had not been out of bed in a year. Her potential for rehab given her state of health was really pushing it. Yet she was stated as a full code, do everything, be agressive with any therapies you can. And that's what she got, but she continued to just exist without any real big meaning behind it.
Finally Dr. Manzon got in there to have a real heart to heart with Helen and her daughter regarding these heroic measures. Helen admitted she was tired of dialysis and the way that it made her feel - admittedly dialysis makes people feel like complete crap, and most times she would only get an hour into it before she'd be in tears. She said she'd thought about not going through all of this if it was just prolonging things. Dr. Manzon asked her if she knew the consequences if she stopped dialysis - death within a few days, and Helen sounded quite sure of it. If only it were that simple. Not only was her daughter not going to have any of that, Helen had been married for 60+ years and her husband was at home, awaiting her return and telling her to push through it even if it hurt.
I had a conversation one day with Helen on one day when she was particularly responsive to answering questions and apparently her husband and her had met down at a service station and the story with old folks is always the same - "he was interested, I was not" - and at 18 years old she was engaged to be wed and they'd been happy ever since. The secret to marriage, she answered, was "always working at it." She told me randomly that she hated "hearing him cry on the phone."
Heavy. In reality this poor woman was so ready to die, but she was not being allowed to pass away comfortably because of her family's wishes. The word ultimately comes from her, but she couldn't bring herself to say the words "stop dialysis" or "DNR" because she was so afraid of hurting those around her. You can't blame the family necessarily, though -- who wants to let go of their mother or lifelong partner?
But this experience taught me a valuable lesson - someone's life is ultimately their own to live, as well as ownership of their death. This lady was tired of how she was living but felt too guilty to die. An ultimate sacrifice for love? I'd say so.
That leads me into thinking about that song by Boys Like Girls with Taylor Swift, "Two Is Better Than One," where they go, maybe it's true, that I can't live without you. I never put forth much thought to this statement as more than a rhetorical one, but maybe it is more concrete than we think.
The only part that doesn't fit is the line, but there's so much time to figure out the best of my life -- what do you do when this isn't true anymore?