ShareThisA collection of creative nonfiction essays about end-of-life issues. How depressing, a friend said.
I thought the same thing until I read one and then another and then another.
Sad, yes. But depressing? No. "Twelve Breaths a Minute: End-of-Life Essays," a book commissioned by the Jewish Healthcare Foundation as part of its ongoing end-of-life initiative, is uplifting.
The 23 essays, chosen from among more than 400 submissions, also are beautifully written. The writers are the sons, daughters and parents who have had to deal with the deaths of family, as well as members of the medical profession who have had to balance the oath to save lives with the desires of a patient to die without extraordinary medical measures. Sometimes they are both.
The book was edited by Lee Gutkind, a writer in residence at the Consortium for Science, Policy and Outcomes and a professor, both at Arizona State University.
Consider the piece "Whose Failure Was It?" by Dr. Jonathan Weinkle, a pediatrician and internist who sees patients of all ages at the Squirrel Hill Health Center in Pittsburgh and who is involved in the foundation's end-of-life initiative. He ponders how his patient Mollie, a 95-year-old dying woman, comes to be admitted from a hospital emergency room to an intensive-care ward just 48 hours after saying she wanted hospice at home.
Tubes and restraints are placed, placement of a pacemaker is tentatively scheduled and minimal pain medication is given before Weinkle arrives and takes over the next morning and atones "for our failures of the previous night."
Mollie had told the ER doctor she wanted "everything" done to save her. But her 88-year-old sister Yvonne tells Weinkle that Mollie "was talking out of her head" when she said that.
Weinkle asks why the family went along with a hospital admission. "What choice did we have?" the sister answered.
Eventually, he arranges for a palliative-care doctor to see Mollie in the hopes of eventually returning her to hospice at her home. A few hours later he got the message from the hospital that Mollie died just as the palliative-care doctor arrived.
Thanks to Weinkle's interventions, she died peacefully in her sleep "without an endotracheal tube, a central line, a feeding tube and a couple rounds of dialysis ... not even a pacemaker. It was a small measure of success after a string of failures."
Oakland, Calif., author Eleanor Vincent writes in "The Resurrection of Wonder Woman" of her decision to donate her 19-year-old daughter's organs after a fall from a horse left her brain-dead:
"Since her death on the afternoon of April 6, 1992, I have lived with the unspoken fear that I abandoned my child to organ-retrieval surgery when she was still breathing and her heart was still beating. Rationally, I know that her breath and heartbeat were mechanically induced, but she still looked alive, requiring me to suspend the evidence before my own eyes and trust that brain death was also real death." Still, when Vincent met the recipient "and listened to Maya's heart beating in his chest, I had the oddest sensation that she was there, still vital, still alive."
Poet Eve Joseph of North Vancouver, British Columbia, writes of her years of hospice work. "To work with the dying is to wade into mystery," she says. She uses as an example "the man on his deathbed who tells you a yellow cab has pulled up outside his house, and even though the taxi has the wrong address, he says he'll go anyway."
In writing about the extraordinary measures requested futilely by a patient, leukemia specialist Larry D. Cripe notes that surveys show that most Americans would prefer to die at home, yet more than half of those who die each year do so in a hospital or other health-care facility. "Thus death in the hospital, especially in the ICU, has become emblematic of the question both patients and physicians face countless times each day: Is the technology a blessing or a curse?"
Depending on the outcome, it can be either, but in the end everyone has to die. Whether that death is peaceful and pain-free depends on whether the patient has directed the family on his end-of-life wishes. If you haven't yet made those wishes clear, read "Twelve Breaths a Minute." Then you will.
(Email Pohla Smith at psmith(at)post-gazette.com.)
(Distributed by Scripps Howard News Service, www.scrippsnews.com.)
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