Ted's Text

Ted’s text haunts me.

The scenario: I am drifting away, calmly, peacefully. My last two years have been difficult, times of pain and immobility but yes, also moments of intense joy.

         But I am ready. The carbon dioxide in my blood  has made a dreamscape of the Brigham’s  Boston campus.

         This would be a good death.  No  stroke, no searing chest pain.  Kids are grown, wife  intelligent, funny and attractive enough to find companionship when I’m gone. I had the rare luck of finding my calling as a physician . Unpublished novels aside, no bitterness.

         My bags are packed,  I’m ready to go

         I’m standing here  outside  your door

Cyn has made it clear to the house staff that I am not to be intubated if I stop breathing

Then Ted sends Cyn a text.  I’ve known him eight  years.  He is smart, humble, and knows my peculiar situation.

He has watched me decline. He knows I love to ski, hike  and take 100 mile  bike rides. He knows I now walk slowly, stiffly. He knows Cynthia, and how she has suffered.

He is no stranger.

So why  the text?  WE NEED TO INTUBATE STEVEN THIS IS A TREATBLE PROBLEM AND HE WILL RECOVER

Does he understand that  my quality of life is poor?  Does he really believe that a 59 year old in poor health will ever recover after  being on a ventilator?  I have lived a remarkable full life . Does he understand that  I have already seen London, I’ve seen France and, in my prime, saw women’s underpants?

A deeply unsettling aspect of our relationship is that  I have sent him patients.  Some have not done well.  We shared a patient in clear decline. I kept asking  Ted  if  hospice was appropriate . “No no, this is a treatable cancer, we’ll push on”

The patient  died, horribly, a “full code”  of gore and broken bone .

 Am I on the same  glide path?  Am I being spared a shot at a good death because a possibly worse one awaits?

         So why the instance that I be “Full code?”   Is it that  we have become friends and he  feels  bad for ne, and this was a misguided but touching display of concern? Perhaps an ego thing,  prolonging my life to add good data to a planned paper?

         I mention this because  I have found  my patients who get the best care are those who annoy me… slightly. My patients who have become family over the years have a problem. I love them, and don’t want then to die,  Perhaps I’m more  likely to shrug off a slightly elevated  liver function because I want then to be healthy.  The patients  that irritate me   get the best medical care.

Pt X has been my patient  for 20 years. X   is always in pain, always  mentions symptoms  I suspect may be due to depression, although X refuses to seek counseling or medication.

X presents  with  lower left  back pain .The story sounds off for skeletal or osseous  pain.    If  X were a beloved patient, I would probably reassure.  Why expose a loved one to excess radiation?   

I also suspect she would be furious if I  missed anything. In any event, I somewhat passively aggressively ordered a Real CT, showing an early  renal cancer. She is doing well.   

Moral of the story is to make sure you annoy your physician on a regular basis.  The best way to do is to insist on a 15 minute visit and bring in a typed list of  at least 10 symptoms

Oncologists  have to remain optimistic . If they weren’t, their job would consume them. I always feel better when Ted  reassures me that I will get better. I am willing to suspend  disbelief.  

I am glad to be alive. I am glad I am DNAR.  The term “Do not resuscitate” was changed  to “Do not attempt to resuscitate ” because  the original phase implied. Resuscitation was a likely outcome.

When asked, most physicians would want to be DNR, because we have seen the horrors of  resuscitation.   So why  did Ted want me to be  Intubated?

Make your wishes  known now,  document  your advanced directives .Patients think its ghoulish  to discuss, but the opposite is true.   You don’t want your loved one to make a decision about your  terminal  hospital care without your guidance.

          I have had the good fortune to experience my own DNAR death. It was great. Had I been intubated, as the house staff requested, I’d probably  be in a nursing home right now,  too depleted for rehabilitation .

So, why the Text from Ted?