We’ve gotten really good at what we do. Have you noticed that? Hey, I’m all for it, for the most part, and if you or your family have come through my doors, you probably are too. The technological advances are amazing, and the things we can do are such a blessing to so many! I mean, diabetes used to kill little kids, but now modern medicine gives us the ability to live longer despite chronic illness. Widow Makers no longer make widows as much anymore, and the number of people who survive things like a ruptured aortic aneurysm has increased. Teens are surviving that deadly car wreck that no human should have survived, neonatal medicine saves babies that would have been doomed, and cancer no longer automatically spells death sentence. It’s wonderful! Except when it’s not.
It’s been going on a while, but I’m starting to see it more and more. I can glimpse pieces of the unraveling fabric that is good medicine. I can see where healthcare fails by being so damn good. I watch us become our own worst enemy, playing God a little too sufficiently, and we’re left with nothing but the hope that He can get us out of the mess we ourselves created.
Let’s say an elderly woman walks into the grocery store and falls face first into the frozen food shelving. Her heart has stopped. The blood is no longer pumping to her vital organs, and without that precious blood she lacks one other important ingredient for life. Oxygen.
A bystander who remembers enough from the community CPR course they took last summer arrives to the scene and initiates first response. 9-1-1 is called, EMS arrives quickly, the woman is zoomed to the nearest ER (which is really close because we’re building more and more satellite ERs everyday). Everything goes seamlessly, y’all. The CPR was high quality, the paramedics fast-acting, and the ER physician on-point, but despite the stellar work of the healthcare team a delay in the previously mentioned oxygen happens. You can’t die and not suffer some sort of repercussion of that, but what’s changed is how easily we can go forward from there.
Is your heart too weak to pump on its own? No problem. We have a machine for that.
If you don’t have a blood pressure high enough to pump blood throughout your body, no worries, we have medicine for that. A good handful, actually, and we’ll give you the maximum dosage of every single one!
Can’t breathe? You guessed it. We’ll breathe for you! You just rest a few days and we’ll handle the tough stuff.
And while all these advances are amazing and much needed, the problem is that sometimes they aren’t. Or perhaps they shouldn’t be. The problem with getting so good at playing God is dealing with the consequences of our actions.
So, remember our 86 year old grandma who passed out by the frozen ice cream? Well, ice cream is part of her problem. According to lab results and an ultrasound of her kidneys, she hasn’t been controlling her diabetes. Her kidneys are shot, her body is in shock, the waste isn’t exiting her body like it should, and all those life-sustaining medicines we’re pumping in aren’t really being dumped out on their own.
No problem, though. We can be her kidneys. We got this.
She’s swollen to the point of her skin busting, and her nurses are changing pads underneath her constantly from the fluid that is literally oozing out of her pores. We have medicines for this too. We call it a balancing act, you see, maintaining a blood pressure compatible with life while pulling off excessive fluid. As of now, it’s building up, backing up from her already damaged heart into her already supported lungs.
Kidney failure, heart failure, respiratory failure, these are nothing new to your critical care team. We see it all the time, and we’re pretty frigging good at keeping you alive despite all the failing organs, infection, and unexpected complications. What I’m trying to say is maybe sometimes we’re too good.
See, we’re great at fixing what’s broken, but some things we cannot fix. We can’t fix things like our precious aforementioned grammy not getting enough oxygen flow to her brain before her heart was restarted. We can’t make an EEG show brain activity when none is there. We can’t cure chronic conditions; we can only extend the life of them. And even then, when is enough enough?
I don’t want to sound heartless or cruel, because that’s not what this is. It’s the opposite, in fact. It’s the voice of a caring bedside nurse who sees the pain in a daughter’s eyes when her mom’s poor prognosis is explained and she’s asked if she wishes to withdraw care.
The blessing of healthcare is we’re so good at what we do.
The curse of healthcare is we’re so good at what we do.
We can artificially feed an individual who has no awareness of the world around them. We can do this forever.
We can bring back and sustain a life that probably should have moved on to Heaven. We can create prolonged suffering. It’s not the intention, but it happens. Without our high-functioning intervention a son would have had to suffer through the unexpected, quick death of his dad. But, he wouldn’t have had to watch his father waste away, a shell of himself, skin turning purple, skin breaking down. I don’t say these things to downplay the travesty, but rather to highlight it, to bring awareness to the devastation that can occur when a body lives on, when perhaps it should not have.
So, where do we draw the line? I wish I knew. As of now, we have advanced directives, and unless those say otherwise, we, as the healthcare team, will fight tooth and nail to ward off demise. We will throw a patient everything we have, which with today’s technology, is almost literally the kitchen sink. And I am so proud to be a part of these crusaders against death. Sometimes, though, in retrospect, you see the suffering all around you and you wish you hadn’t.
When keeping a body alive hurts, and there’s no known or likely chance of recovery, you wish you weren’t so good at what you do. When the lights are on, but no one is home, you wish nature could have taken its course. When suffering is prolonged, healthcare almost seems like hurt-care.
The number of nurses are declining, but the number of patients are increasing. People live longer (which is a good thing), but sadly a large number of the bedside nurses who see on a daily basis the suffering of patients, they’re leaving that same bedside. They’re going to further their education or into administrative positions where they don’t have to explain to another family that their loved one has zero chance of recovering after they were revived.
Quality of life is sacrificed just for life, often times a shell of one, and it’s not up to nursing to decide what is considered quality and what is not. They just watch from the sidelines where that conversation is concerned. It’s emotionally exhausting, and I think where a lot of burnout derives. Many times the healthcare team is the only one that sees the reality/downfall of sustained life that should be let go. The families don’t come. They call frequently, make demands, but they don’t come to witness the hard stuff. I get it; it just doesn’t make it any easier in the end. I can’t tell you how many hands I held when they needed it most.
But I guess that’s what we’re here for, right? We’re here to save them, and to rejoice when they improve. But we’re also there to suffer with them as they slowly die. It’s hard for everyone involved. I suppose we take the good with the bad. We give a man with a 100% blockage to his heart muscle a second chance, where he holds his grandkids, and sits on the front porch swing with his wife. But we also break ribs. We put surgical holes in people, place lifelong tubes there, and whisper a desperate prayer as we try and do no harm.
I try to focus on the successes. I try to listen to God’s voice really hard. I pray. I pray a lot. But mostly I just love on folks. Every single one. The ones we save, the ones we don’t, the ones we shouldn’t have, the ones where we didn’t know. Because in the end, many times, love may be all we can give.