In my last post I spoke of how there is never one hundred percent or zero percent certainty in medicine.
Last week we admitted someone to our ICU who taught us that this same uncertainty persists right up to what at first seemed like an indubitable conviction about dying.
Charles arrived in our ICU after his cervical spine surgery had gone wrong. He had gone into it with open eyes, knowing that the odds for a successful cervical spine fusion were slim, but it was his last chance to stem the progressive paralysis that had started weeks ago in his legs and just days before had rapidly began to cause weakness in both arms. He could no longer walk, and then he couldn’t lift a fork to his mouth.
The degenerative disc and vertebral body deterioration had progressed so completely that two orthopedic spine surgeons had turned him down. Too high a surgical risk. Not much there to hold the desiccated bones together. His spinal cord was being choked.
But one of our young neurosurgeons took him on. Our surgeon was known for this…operating on cases seemingly devoid of hope.
Charles awoke from anesthesia totally paralyzed. No movement below his neck. In bed he looked like a grand statesman to me; calm, white-haired, brave and telling us again and again how grateful he was that someone had tried.
Then he asked for medical aid in dying (MAID).
Our state, Oregon, was the first state to legalize this practice. Physicians have a moral obligation to alleviate suffering and preserve dignity. But this wasn’t suffering in the face of a terminal illness, like stage four cancer. It was, however, an existential suffering, a loss of “personhood.” A loss of who Charles was.
Many thoughtful discussions took place with his family and friends surrounding his bed, confirming his unwavering decision. It struck me that I’d never seen this steely a resolve. Most people still have questions, still have uncertainty. Charles, however, expressed his request for MAID like an order. He had long been the CEO of a medical device company, and orders came naturally to him.
The Certainty He Borrowed
In our ICU we have heard requests for MAID before. But rarely one without one iota of doubt. And so, we remained deeply assured…Until, just before he was to be discharged, Charles’ longtime college friend arrived from New Zealand. Charles’ friend took me aside and said something that gave me pause. He said what Charles had said in those many discussions with palliative care and the MAID physician facilitator was a bit of an act.
In unequivocally expressing his desire to die, he gave his wife and daughter a gift…shielding them from any doubt that may have remained in their hearts. I thought it striking that this understanding came not from his wife of 43 years, but from a college friend from 50 years ago, who had known him then, in youthful times so very far from any future thought of a momentous bedside decision to die.
