Puzzles Between Life and Death
Story: Sheng-Jean HUANG,
Author: Ling-Huei LIU
Publisher: Locus Publishing Company
Published Date: 2010/11
In intensive care unit, one neurosurgeon experiences the realities of death. Contradictions and conflicts includes those among family members, and those of family members with medical personnel, even between different hospital departments. Some of these conflicts are so extreme that they might strain believability were they to appear in a film.
Lying in hospital beds, patients can be in deep coma and totally unaware, and yet, hooked up to ventilators. They are still breathing, and their hearts are still beating. The moment arrives when the heart stops. CPR is administered for 30 minutes accompanied by the cracking sound of the fractured ribs. The pulse have not regain. The defibrillation dose increase from 100 joules to 200 joules, and on up to 360 joules... scent of charred flesh wafts through the air.
From the beginning of their medical education, doctors are told: “A doctor’s mission is to save life with your best effort!” But the professors never taught what a doctor should do when limit has been reached. Doctors may not be able to get throught his own commitment, that is to save lives at all costs.
Extracorporeal membrane oxygenation can blacken the limbs. Endotracheal tube can loosen patient’s teeth. The repeated chest compression can break ribs, damage organs and cause bleeding.
“Am I tyring to help or to harm?” he wonders.
A withered 80-year-old grandfather approaches his son’s primary physician and abruptly kneels. “My wife and I didn’t have a child until late in life,” he says. “If my only son becomes vegetative, what will his children do?” The old man’s wife slowly walks over, with three clinging grandchildren. Two of them have Down’s syndrome and the third has lupus. Not yet ten years of age, the children hide shyly behind their grandmother.
“We truly don’t have the ability to care for a human vegetable….”
“When seeing the two white-haired seniors in tears, what should the doctor to do? Save the patient? Not save the patient? If he insists on saving the patient, he will condemn the family into hardship. How will they survive? But if he doesn’t save the patient, how will he face his own conscience?
【About the Author】
Sheng-Jean Huang is an associate professor of neurosurgery and critical care at National Taiwan University Hospital and the superintendent of NTU’s Jinshan Branch Hospital. For many years, best effort has been put to promote the concept of palliative care in critical illness, courageously challenge against the stubborn concept that doctors must extend life at all costs, regardless of the consequences, despite skepticism from the medical community.
After patient’s death and the postmortem arrangements have been completed, family replied: “Thank you, Dr. Huang. Thank you for accompaning us to go through this difficult journey in a dignified manner!” This is the ultimate reward to Dr. Huang.
Ling-Huei Liu is the senior editor of Locus’s CARE series.
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