Otis was our first baby. He was covered in a caramel colored fur, weighed 150 pounds and was the best Bullmastiff dog anyone could ask for. He protected me from my husband’s incessant tickle attacks and thought that my lap was the best place for him to try and sit.
Two years ago, I was walking Otis and he suddenly collapsed. After an extensive workup including an EKG, blood work and an ultrasound of his heart by the doggie Cardiologist (yes, they do exist), we started him on a new regimen of medications for his heart failure. It cost $300 a month but was worth every penny – almost overnight he was a new dog, back to his usual daily routine and enjoying all the activities he loved most in the world.
About a year later though, he started declining again. His favorite spot to sleep was on the floor, right next to my side of the bed. But our bedroom was upstairs, and he just couldn’t make it anymore. He had to sleep by himself. He couldn’t go on walks. He slowly but surely began to get left out of family activities, and for a dog who was as much a part of our family as a pet could be, this was life-altering. He couldn’t participate in any activity which had previously given him joy. He was becoming more and more isolated, becoming physically separated from the people he loved most in the world.
That’s when I knew – it was time to say goodbye. It still hurts, but I know it was the most unselfish and loving thing I could do – focus on him, his wants and his needs, instead of me and my own.
As a trauma and critical care surgeon, all too often I see families struggle in the intensive care unit with loved ones who have devastating diagnoses and injuries.
Now if only most of us treated our parents and loved ones as we do our pets – knowing and respecting their wishes, valuing the quality of their life over the quantity.
Granted, I never had to ask Otis what he enjoyed in life, what his priorities were or what kind of life he wanted to lead – it was pretty self-evident. Your loved ones are clearly more complicated than that, and that’s even more reason their wishes should be known. Do they want to be kept alive by machines with no hope of a recovery that would allow them to participate in their favorite activities? Or be able to participate in relationships with their family? Do they want you to try everything no matter what the outcome might be? If they cease to enjoy eating and can’t communicate anymore, do they want you to put a feeding tube in them? These are the types of questions and conversations that I implore you to ask and have with your family members – no matter their age, no matter how healthy they are at this very moment, because things can change for any of us… in an instant.
In situations like these, my role as the intensive care physician caring for your family member is to find out what HE or SHE would want if they could speak for him or herself, not what anyone else wants. But I’ll never know your loved one like you do. I don’t know what they value in life, what they hold most dear. That’s why I need YOU to help me help them live or even die in the manner they’d want. Because let me tell you, there are a lot of things I can “do”. But your job is to help me make sure I’m doing these things for your loved one, not to them. I’m not asking you to make a decision, I’m asking you to tell me more about them. You aren’t “turning off” any machines, you’re telling me what kind of life your loved one wants… or doesn’t want, and it’s my job to help make that happen to the best of my ability.
Many of you may already know the answers to these tough questions, but I know just as many of you may not. Nope, it’s not going to be a fun conversation. You’re not going to enjoy it. But don’t let your fear of the conversation prevent you from being able to speak for your loved one because they physically can’t. Don’t let your discomfort then put you in a situation whereby you’re not honoring your loved one’s wishes, simply because you don’t know how they’d want their life to end. The greatest sign of love is selflessness – be selfless enough to have the conversation. Be selfless enough to honor their wishes. And know, when the time comes, you’re showing your love in the most profound way possible.