I still get chills thinking about the moment I decided to go to medical school. I was bored in my college physiology class, watching the minute hand on the round lecture hall clock.
There were just a few minutes remaining in the class, and students were starting to pack up. The professor, Dr. Adams, said, “I want to talk about hemorrhage before you go.” His voice was getting lost in the clatter of shuffling papers and closing zippers, but he kept lecturing. “When there is a trauma, and someone is bleeding out, the blood vessels in the extremities constrict to maintain blood flow to the most vital organs — the brain and the heart.”
Something in me froze. Time seemed to stop. Despite the noise, I could hear nothing but his crisp voice at that moment.
You see, I had fallen in love.
The beauty of the human body took my breath away. Up until that moment, I had been studying to become a biomedical engineer. I had spent my entire college education learning how to simply replicate body systems. After all, one of the ultimate goals was to learn how to grow organs and tissues in a lab.
But hearing my professor’s voice, I realized the body is too sophisticated to be replicated. It is our most — the most — magnificent tool. Our organs work in harmony like the instruments of a symphony. Each knows its place and how to work as a team. Even in the catastrophic situation of hemorrhage, the vessels in the extremities know to continue to work to feed the most sacred organs. We could never come close to copying its seemingly intelligent design in a lab.
We each get only one body, and it is an extraordinary tool. I suddenly lusted to learn everything about it.
I had my work cut out for me: I was going to go to medical school.
Fast forward seven years when I graduated from medical school. I was in the first year of my residency, standing in scrubs in the intensive care unit.
However, during just the first few days of my time in the ICU, there was a seismic shift in my admiration for medicine.
I was looking despondently at a body that was being kept alive with machines. It seemed that every orifice had a tube in it. Some extra holes had even been made for the overflow catheters to be inserted. Despite all the life support, this person was not going to live. And we all knew it. But here we were, marching to the end — no sight of surrender. The machines beeped, the little lights flashed, and we plowed on.
The field of medicine can perform miracles at times. We have life-supporting machines that can breathe for our lungs, filter blood for our kidneys and support the blood vessels when the whole network is collapsing.
In this patient’s case, life support was acting as a scaffold, but this body was still crumbling under the weight of age and sickness. All of the king’s horses and all of the king’s men could not save this patient.
The body is a beautiful and almost godly tool. But there comes a time when a body cannot be saved in all of its might and with all the advances in modern medicine. It is at this time we need to know when to stop fighting in a battle that will not be victorious. This is not giving up. It is understood that every tool has its limits.
Just as no one wants to see a superhero bent over and bloody in a losing fight with a villain, no family members should have to see a loved one’s body have its last breath on a ventilator.
I went into medicine to save the body, just to learn sometimes we need to let it die. When it becomes clear that it will not recover despite its splendor, the most respectful thing to do is to allow the body to concede on its own terms.
Too many times in medicine, we avoid these honest conversations with the families of critically ill patients. There often is a point in a patient’s care when we should be saying, “The end is very near. How would your loved one want to spend their last days of life? With tubes and machines to the last second? Or machine-free and family at the bedside?”
We avoid these conversations because, many times, it is easier to charge on. When a person will not survive the hospitalization anyway, it is emotionally easier to continue with life support until utter defeat. This is due to various reasons — fear of malpractice, wanting to “do everything” and expectations from the patient’s family members.
However, the main driver is that this conversation makes everyone uncomfortable. It is easier just to let the science fail and throw our hands up at the end.
But we owe this ace card to the body. When all of the medicine cannot help anymore, we need to give the gift of a peaceful death back to the body. At that moment, it is time to remove the life support and all the scaffolding and allow the body to concede on its own terms. We owe it to this magnificent tool to rest its own case.
Eleanor Tanno is a family medicine physician.
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