Wednesday, January 23, 2013

TING AND I, Hospitalization, Will to Live

The children’s book author Dr. Seuss penned a story about Horton the elephant, who, having agreed to keep an egg warm on behalf of its absent mother, encounters many difficulties in fulfilling his pledge. Surmounting each of them, he proudly announces “an elephant’s faithful, one hundred per cent.” I’m happy to reassure Tina occasionally that I have the same philosophy and am not going to be outdone by Horton.

Horton Hospital, part of Orange Regional Medical Center (ORMC) in Middletown, NY, was the site of Tina’s 100-day battle against death from February to June of 2004. We have been ever so thankful to the nurses and doctors there who saved Tina’s life. No, it was not named after an elephant, but they succeeded in a big job.



Tina caught at least two different infections while in the critical care unit of the hospital. Elsewhere, and at a different time, I picked up bacterial and viral infections from an invasive procedure by an urologist. In Tucson, my mother suffered damage during a heart catheterization. The mother of a neighbor at Lake Osiris died of a systemic infection after her colon was punctured during a colonoscopy. There are simply still much too many medical errors occurring, leading to what are termed “iatrogenic,” doctor-caused, illnesses. Near the age of sixty, I had a virtual colonoscopy, a CT scan of that area, involving no endoscopes where the sun does not shine. I will do the same at 70. The loss of some detail in the exam is offset for me by the gain in safety and peace of mind.



I’ve learned of patients who have refused treatment and died. Keeping Tina from getting discouraged has been a priority, as has not misleading her with false hope. I summed up what I asked our nurses to do as “keep her safe, healthy, and content.”

Since her near-death experience, she has shown a continuing will to live.

My love for her and her love for me is part of what keeps her going. She loves Phil and Ted and some of the other members of our families. She loves, or nearly loves, some of our nurses and they reciprocate much of that affection. She enjoys what entertainment we can arrange for her TV screen.

When I hear discussion of “quality of life” as a characteristic, a “metric,” to be evaluated for access to medical care, I am uneasy. Before you are ill, you have one opinion of what you would want done for you. When ill, a different opinion is likely. When recovered, your evaluation will probably be different still. Even less well informed are the opinions of those who would judge your situation. Given the problem of perspective and given the shifting degrees of mental clarity, one must be very careful about the issue of “informed consent” for various proposed options.

In the hospital, I was asked several times to sign a DNR order for Tina. If her heart were to stop, a DNR order would limit the efforts taken to revive her. I refused to sign, believing she would come to want all efforts attempted, as I did. I have learned that sometimes the very existence of DNR orders suggest to the staff that little more need be done for the patient, who then becomes second-class, lower-priority. The institutions would deny this, of course, but the eagerness for having DNR orders suggests otherwise. At the least, they may serve to shield staff from liability in the case of premature death.

I have been told of a beautiful woman who suddenly became permanently bedridden. She told the staff to close the blinds on the window, to leave her alone, and she refused treatment until she died.

The will to live is necessary, even if not sufficient.

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