Die at Home.
Die at Home.
One thing I've learned from 500 Medevac flights
My grandmother is a saint, every bit as dignified as Queen Elizabeth II. I remember her telling me and others in the family on more than one occasion, maybe 25+ years ago, that she and my grandfather, God rest his soul, had living wills, and that they were not to be subjected to “hero measures.”
Life on a feeding tube in a hospital bed was not worth living, and Jesus was on the other side waiting, so she reasoned. More recently, at age 91, she spoke of things that will be happening in six or seven years, when she presumably isn’t around. I joked with her, “Never know. You might mess up and live that long!” In good health, happy, and sharp as a tack, she laughed out loud and said, “Lord, I hope not! It’s hard living in this old body!”
Since that time when I was a teenager, I’ve heard a lot of mixed reviews from Christians on the subject of “living wills” and end of life care in general. Much of it has been colored by the Terri Schiavo case. The concern has been about the possible overlap between end of life care and euthanasia. Certainly we do not want to open the Pandora’s box of ethical dilemmas that is euthanasia. Yet simply getting old and dying can present individuals and families with a really big set of decisions they’ve likely never given much thought.
I love my job. I can’t imagine a job better suited to me than Medevac helicopter pilot. Yes, I have 3am flights for unimpressive ailments just because there are no ambulances available for hospital transfers. Yes, sometime ambulance paramedics call us to fly patients for things that ultimately didn’t require it. But the worst is when we get called to fly an 88 year old woman with COPD, lung cancer, liver and kidney failure, sepsis, and dementia.
Of course there are all manner of lesser combinations thereof, and sometime it’s grandpa. But there comes a time when they just need to fly to Jesus in the arms of the angels, not to a level 1 trauma center on the stretcher of a helicopter.
That may have sounded funny to those who share the morbid sense of humor common among emergency room staff. And yet in reality, we do find it very sad. The patient could have spent their final hours at home, or in the home of a loved one, just like most everyone did for all of human history. That should be the goal for you and your family members.
Of course some of our patients are flying because there is no family, or they don’t want them. The nursing home doesn’t want them. The local hospital doesn’t want them. Have a family. Treat them well.
The strange fluorescent light of a hospital, it’s scent of sanitizer, the unknown voices of people you don’t know and who don’t care about you, are glaringly inferior to the hue of home, it’s smell of coffee and bread, the voices of kin and lifelong friends talking, laughing, and singing hymns and reading scripture. Much more is home a superior comfort to the unearthly screech of a starter motor, the explosive roar of a gas turbine light-off, the harsh high vibrations of spinning machinery, and the cold or hot blast of rushing air. Yes, when my body is trying to release my spirit, let me be at home.
Even when the ethical line is clear, attempting to save the life of an elderly person can be horribly ugly. In over 500 patient flights I’ve seen a few things. I’ve smelled all manner of bodily excrement, burned flesh, and alcohol laden blood. It’s never made me queasy. I’ve flown pregnant women who will die soon without surgery, suicidal failures with exit wounds on their face, not quite dead yet, and children who were run over and still had tire marks on their skin. I never got emotional or cried.
One night I almost did both.
We flew an 80-ish year old woman, who had been resuscitated twice after a heart attack and cardiac arrest, from a small rural hospital to a large city hospital with surgical capabilities. She was conscious when we landed and got her out of the aircraft, but never spoke. She just looked at us and nodded when spoken to.
I usually don’t accompany the crew inside but the helipad at this particular facility was a long 3 minute jog from the operating rooms. Due to some miscommunication, or perhaps a fight in the ER or some other hospital drama that had to be dealt with, security was not waiting on us. So I helped get the patient onto the gurney and push her at a running walk down the long hallways of the hospital.
I held the patient’s hand, also a rarity, from the time we left the helipad all the way to the O.R. I had made eye contact with her while we were still under the stars and it just made sense. Somewhere around half way there the patient had loosened the small amount of grip she had on my hand. The nurse used a choice word. “S*#t! We’re losing her! Run!” Our speed wasn’t going to change the outcome, but we sprinted for a minute or so to complete the transfer.
We arrived at the O.R., our nurse yelling out to the scattered staff. “Patient’s in full code!” Within 30 seconds there must have been 10 more people in the room, each at a predetermined station with a tool, a machine, or arms ready to lift. The patient was swiftly and unceremoniously jerked from the gurney to the table. Her right arm and breast fell from under the side of the hospital gown and her head flopped to the same side, eyes open and blank.
“Starting CPR!” a large young fit man on the other side of the table took off his scrub top and hunched over the patient in his t-shirt. He’d done this before. Unusually involved thus far, I felt I had the right to stay in the room, if out of the way. He started to slam down on the patient’s sternum in a quick, repetitive, and exhausting motion, aiming for 100-120 compressions per minute. Bones started to break. The patient’s head bobbed on the table, eyes blank, mouth limply opened, tongue starting to protrude. “Two minutes!” The nurse stopped pounding the chest, stepped back and leaned over with his hands on his knees breathing like a sprinter after the race.
“Analyzing heart rhythm! Do not touch the patient!” A small 30-ish year old woman with fading bleached blond hair peered at a screen. “Patient’s in V-Fib! Charge to 200 Joules!…Everybody clear!” “I’m clear! You’re clear!”
The patient convulsed with the jolt of electricity, seemingly bouncing herself on the table. “Continue CPR!” The big dude got back after it. Another 2 minutes elapsed and the same routine with the EKG and the defibrillator happened again, and again. I had been an unemotional but technically interested observer up to this point. I like medical stuff and I’m not squeamish. My conscious mind was not traumatized. My adrenaline wasn’t up anymore. My heart rate was normal.
But then the sum total of the indignities, the cruelties, and the gruesomeness registered somewhere deep inside me. The flopping hand, the swinging breast, and lifeless face of the woman who’d looked up at me a few minutes ago, were being brutalized. I felt the blood drain from my gut and I became nauseous. I took two or three deep breaths to regain my composure. It didn’t work. I turned and walked out lest I add a vomiting onlooker to an already problematic situation.
I walked down the hall 50 feet or so and my body ceased its protest. Coming back I found a chair in the hallway not quite in front of the door, so I sat down. Not a minute later two women appeared in the hallway walking fast with tear streaked faces. It was the daughter and granddaughter I assumed.
“Is she OK?”
I pursed my lips as I thought how to answer. “They’re doing CPR. It doesn’t look good. You probably don’t want to be in there.”
They went in anyway only to depart the room within moments. They half knelt and fell into spontaneous sobs and prayers. My crew had packed up their things and walked out the open door only a few seconds behind them. I was praying silently and ready to leave, blinking the water back into my tear ducts and clearing my throat. A hospital nurse showed up to guide them through this hard hour as we walked away.
I have no judgment for the decision to resuscitate the woman and try to keep her alive. If it had worked she may have had years left to hold great grandchildren and enjoy many more Sunday dinners with the family. Yet it was still awful to watch the failed attempt. Many family members who initially make the decision to attempt CPR on an elderly relative quickly reverse their choice. It’s really ugly.
What is more concerning though is when we take an elderly and terminally ill patient far from their home to keep them “alive” for what might be a day, a week, or a month. I recently flew a woman in her late 60’s who had cancer in every limb of her body. She had sepsis and was in respiratory distress. She was dying, and there was nothing anyone could do but actively prolong the torture, like some strange Soviet or Nazi medical experiment. Doing nothing would have been far more humane. I don’t fret the wasting of resources. I lament the lost opportunity for the family to witness the reality of normal death and to provide comfort to the dying.
Death is so sanitized, if not outright hidden, in our day. The illusion of immortality brought on by modern medicine has convinced us that technology will painlessly save us from nearly anything so long as there’s money to make it happen. But it won’t. It is appointed unto man once to die, and after that, the judgment.
I want to die at home. I want to go with my closest kin singing me into glory. I don’t want to hear a single “machine that goes, ping!” Of course this may not be possible. Death might sneak up on me in a hospital. But there is a line somewhere between fighting for life and futilely running and hiding from death. Based on what I’ve seen, it is not wrong to err on the side of acceptance. “For me to live is Christ, and to die is gain.”
I want to “cross over the river and rest under the shade of the trees” from the shore of home.