Tuesday, October 21, 2008

hot topics.

I didn’t understand what it was for the longest time. I think I first heard the term in 7th grade. We were required to write “topic reports” on some current event in the world, something every seventh grade sociology class makes students crank out. On this particular day, I was waiting in line to talk with the teacher & get the “stamp of approval” on my chosen topic (of which I can’t seem to remember). The girl in front of me got a stern look from the teacher and was asked “Are you SURE you want to cover that topic?” She shot back with a confident answer about how the youth in Asia were so important to her & she’d had exposure to them. She just seemed really passionate about her chosen topic.

Hmm. Weird, I remember thinking. Why is she *so* interested in kids in Asia? I mean, I hear they have dirty water & stuff but so do kids in Africa…why Asia?

It wasn’t until a few YEARS later when I reflected on my witnessed conversation that I realized she wasn’t talking about youth in Asia, her chosen topic was EUTHANASIA. Chalk up one blonde moment for me.

And today I remembered that same seventh grade conversation again. I just started my geriatrics rotation—which is actually much different than I envisioned. I’m a bit of a guinea pig for a “newly established” rotation curriculum (if you can call it that) through the hopsital I'm working with. And because of some scheduling conflicts, I’m working with a case manager at the hospital this week instead of an attending physician.

I was pleased to find out that she is a lovely woman who is quite passionate about her job—not to mention fantastically good at it. And it is actually a breath of fresh air to witness the goings-on behind the scenes of physician orders & patient medical management. A bit of a reassurance, I guess, knowing that I wouldn’t want her job—not to mention the fact that I desperately missed using my stethoscope today (although my back thanked me for the relief from my 10 pound white coat stuffed with instruments & books).

So back to Youth in Asia—err, Euthanasia. Also known as Physician Assisted Suicide, I noticed on my last absentee ballot that it was on the table for passing in Washington State. It is legalized in Oregon & an up-and-coming “hot topic” in many other state legislatures.

To be honest, I’ve tried to avoid the topic altogether thus far in my life, having only vague opinions about the subject—most of which are driven by my faith & the set of morals I’ve established based on that faith. But like many other “hot topics”, my personal opinion is constantly in flux, constantly being molded by the patients I meet, the stories I hear, and the suffering I witness in medicine. And truly, Euthanasia is just a jumping-off-point…there are so many other topics that center around death & dying, palliative care medicine, hospice houses, and other end-of-life issues.

Our culture shies away from death, as if it is some disease to be caught, some preventable & entirely undesirable end effect that the magic of medicine can save us from. But the miracles of modern medicine simply prolong the inevitable—sometimes improving the quality of life, sometimes giving many more decades of memories to families who would have otherwise missed out, and sometimes turning a quickly fatal disease into a process of protracted suffering. What most people don’t realize is that our approach to death is actually a direct reflection of our approach to life.

We discovered that most people meet death as they met life:
some head on, some with denial, & some with passivity.
There is a “death style” as well as a “life style”.
How we die will be an expression of how we have wanted to live,
& the meaning we find in our dying is likely to be
at one with the meaning we have found in our living…
[A] person who has learned how to let life go
may have not only a richer & more flexible life,
but also one that better prepared him for his decline.
–David Callahan

Although I’ve personally been exposed to what I would consider a fair amount of death, some accompanied by irretractable pain & suffering, I’ll be honest in admitting that I’ve shied away from accepting my own death. My faith tells me to embrace it, but I’ve become rather complacent about the whole ‘experience’—perhaps not willing to let go of my life as it stands right now.

And so, I think this rotation will be especially good for me. I’ll share the stories of the patients I come into contact with, those suffering, those hopeful, & those who are excited to meet Jesus. And in the meantime, I’m hoping to get a better grasp on issues that will be important for my future in medicine, issues like euthanasia, advanced directives, DNR’s, & palliative medicine….

And I’m hoping you’ll think a little more about them too...


Craig said...

It sounds like we have some of the same questions coming from the same contexts. I was exposed to a new "ethics" term today: AND rather than DNR - "allow natural death." I learned this term in talking with a family who is deciding this very issue with their 8 year old daughter. Tough stuff.

Sarah said...

Just prep Jon when you bring home your advanced directive. Seeing Craig's funeral plan laying on the kitchen counter was a little startling. Interesting but still weird.

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