How not to die
"I don’t mind dying. I just don’t want it to be my fault.”
A colleague and friend just gave me a book with the whimsical title, “How Not to Die,” by Dr. Michael Greger, for a holiday present.
Of course, everyone has to make that transition sometime. Medicine is ultimately a failed enterprise if preventing mortality is our prime goal. This is a great book that addresses the power of prevention in medicine focusing primarily on the science behind the role of foods for prevention and reversal of disease. It is a fascinating perspective on how large of a role nutrition plays in our health. The author goes as far as to say, “Death is a food-borne illness.”
The literature citations, research and practical tips offered in this book are a treasure trove of information on how to live a healthier and longer life. Consider it as a reading option for improving your overall health.
However, I’d like to change the conversation a bit. When we try to extend life, we need to look especially at the quality of life. Adding life to years is a value above adding more years to life. Sometimes, though, we may lose track of priorities.
Last year I spoke with a patient who had moved here from another state. He told me a shocking story. He had found his wife unconscious on the floor at their home and started CPR. He bravely kept it up, despite being weakened himself from advanced prostate cancer, until the EMS arrived.
In the next week in the ICU, she did not awaken or make substantial medical improvement. She had an implanted pacemaker/defibrillator device that had reportedly been activated over three dozen times during that week. At some point, the family needed to make a tough choice. Shut off the pacemaker/defibrillator and then take her off the respirator or watch her suffer longer. The person they knew was already gone.
The attending doctor who pressed the family hard to leave the pacemaker/defibrillator in place and functioning worsened the difficulty of the decision. I wasn’t there to ask his reasoning, but to the family it made no sense. After being in a coma for a week with multiple complications and several cardiac arrests, their loved one’s brain was likely severely damaged from lack of oxygen and if she could be saved, she would likely be in a vegetative state.
This is just the kind of scenario many of my patients wish to avoid and how not to die.
Please talk to your doctor and family as soon as you can and sign the appropriate Advance Directives and Medical Power of Attorney. These should clearly state your intentions if such a catastrophe strikes. It is never easy, but can help them and your doctors make challenging decisions with more clarity about your wishes.
Medical technology offers marvelous outcomes at times but it has its limits. Also, just because we can do something with a machine or drug or other medical or surgical intervention, it doesn’t always mean we have to.
Be sure you know your options medically and legally to ensure your wishes and values are honored.
Dr. Victor S. Sierpina is the WD and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB.