Article Title: Pressure Injury Progression and Factors Associated With Different End-Points in a Home Palliative Care Setting: A Retrospective Chart Review Study
Authors: Artico M, D’Angelo D, Piredda M, et al
Journal: J Pain Symptom...
By Michael Miller DO, FACOS, FAPWCA, WCC
A friend and colleague is going to die. This of itself is not news as the process of dying unquestionably begins from the moment of conception. This case is perhaps a bit sadder and more morose than many. As health care providers, we relish in the success of prolongation of life. The birth of a baby, healing after an illness and returning to our usual lives, the successful healing of a wound of longevity and strife. And yet the measurement of successful healing, like the measurement of a successful life, is one defined by an infinite number of parameters from an infinite number of opinions.
A Colleague and a Friend
To many, my friend never seemed to catch that lucky break. I will not belabor the ups and downs ad infinitum of her life, as any of you could easily juxtapose your own existence and feel that your own trials and tribulations make anyone else’s pale in comparison. It is easy to look at one's life and wonder what would have happened if I had only done something different or not done something. As far as the value of any life regardless of its longevity, how can anyone put a value on it? Life is unquestionably a perpetual pendulum in which we swing from agony to ecstasy. The most heinous criminals in history were unquestionably loved, respected and held in highest esteem by someone. The most sainted, obeisant, loved people in our lives cannot claim to be universally so.
My friend, while never reaching what others might call the pinnacles of her life choices nonetheless could never be considered a failure. When an early chronic illness caused her a cosmetic concern that others might use as an excuse to hide away in a cave, she almost perversely chose to nonchalantly display it as if it’s presence added, not detracted from her persona. When she first came to meet with me having been offered a job through a business partner to work with my staff in my group, her immediate demeanor was one of confidence and determination tainted with a sense of hesitancy as if to say that she would do what she could do to suit our needs. A spry, elf-like demeanor quickly endeared her to my staff who knew that she would willingly spring into action and help.
A history of a medical school acceptance went unrequited after a surprise pregnancy. Her burgeoning career as a medical paraprofessional eroded by life itself and a badly chosen marriage partner whose universally insensitive, callous attitude made her passion to help others that much more amplified. Of course, no good deeds go unpunished. Her life became more complicated when at the conclusion of acrimonious divorce proceedings, an esteemed member of the legal profession whose humanity and intelligence remained cloaked in the black robes of lunacy and arrogance awarded full custody of the focus of her existence to her spousal nemesis. Women throughout history have committed crimes against humanity worthy of punishments bordering on the Spanish Inquisition and yet, no one has ever heard of a mother losing custody... until now. The decision, never explained by his honor-less, placed my friend and her friends in a state of near catatonia. But Sisyphus had only begun to watch the boulder roll down the hill.
Within the month, her pending death made itself known in the form of a simple cough, no more Nostradamic than the other hundreds I heard at that time. When two weeks of antibiotics failed during a research project evaluation, the decreed trip to the local hospital and subsequent simple workup provided findings beyond the macabre. And with no hint, inkling, sign or symptom of anything more ominous thriving.
The Role of Life and Death in the Work of Health Care Providers
As health care providers, we see ongoing life and death as mere parts of a gamut of human conditions. The death of a toe, the life of a foot, death of a leg, life of a human. I have always tried to simplify my own angst with this dichotomy by reverting to the almost childlike concept of having two halves of my brain... one that uses the clinical, fact-filled, years of education and my practice to gather up the salient and concrete and make decisions in a logical fashion.
The key then is to simultaneously simplify the complicated while complicating the simple and then meet them in the middle. My friend has an advanced malignancy, here is what the tests show, here is what can be done from the ridiculous to the sublime and here are the risks and complications. The die is cast, the choices made based on the facts and findings and we go down the checklist to make sure all the "I"s are dotted and the "T"s crossed. The ultimate outcome is dependent on the tangible with some blurring of the considerations from the intangibles.
But, like everything else that starts off with the cold calculating facts, that other brain forces its way into an otherwise logical process and demands—no—forcibly intrudes into the process. From the simplest care arrangements post-discharge to the impending sale of her now-divorced house in which her life’s possessions begin to lie fallow. The judicial decision to tear her child away suddenly becomes an unwanted yet unbelievably needed prophecy. The surgeon's compassionate offer of a mere year more of life is tempered by the realization that even a year is no longer than a moment and that after that moment, life will go on but without her. We talk about getting her affairs in order, things that must be done (planning her funeral, explaining her condition to her child, where she will go after discharge). These usurp the more important paying of the water softener salt bill and the omnipresent imperative signing up for the youth sports program.
Our Promise as Health Care Providers
As providers, we struggle within ourselves. We take oaths and make promises as we are handed a piece of rolled up paper amongst our loved ones. We are taught to strive to do what is right, best and without personal biases for those whose care and lives our own are supposedly dedicated to. We blithely look to the right and to the left for grass that is less green in terms of our own care and that of others whom we work with or compete against, hoping that our own somehow looks greener...if only for a moment.
A life spent working for the benefit of others is something that saints and madmen aspire to. Good deeds are compensated with punishment. Hope continues when there is none. Celebrations of life spring from harbingers of doom. Self-evident truths fade into deceit with no more impetus than mere time passing.
Shakespeare's Polonius seemed to put it all into perspective when bidding farewell to his son, cries out "This above all: to thine own self be true." We must care for ourselves first, because only then can we be assured that others will receive the care they truly deserve and for which we are defined.
My friend is dying and I mourn with her, the loss not just of her life, but a piece of my own.
Until next time when we ramble together...
About The Author
Michael Miller DO, FACOS, FAPWCA, WCC is the Founder and Medical Director of The Wound Healing Centers of Indiana and IndyLymphedema, as well as a clinical consultant, teacher, inventor, and published author.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.