End of Life Ethics and the Christian Worldview: Pt. 3

Posted: January 18, 2014 in Ethics
Tags: , , , , , , , ,
The Door, that no one is happy to be standing in front of.

The Door, that no one is happy to be standing in front of.

Know When To Fight

In my previous posts, I began a discussion, based on a personal dilemma being faced by my own family, dealing with end-of-life ethics. I intend to be more personal in this post. My hope is that as I work through this emotional and personal struggle, that we can come to some conclusions based on a Christian worldview, and perhaps prepare better for end-of-life scenarios, and prepare better to know when to fight for the life of a loved one. This journey is open-ended. I don’t know where my loved one’s journey will take her or us. We will learn as we go. Hopefully, someone may be helped through this.

My emotions are raw, and I’m feeling numb and exhausted. I am my brother-in-law’s wing-man, and even though he is the one feeling the full weight of this horrible situation, I am close enough to sense the powerlessness and confusion of it all. The endless hours; the feelings of hopelessness; the anger when the step-down facility thinks a DNR means “do not help the patient at all”; and having to be the grieving spouse, critical care nurse, respiratory therapist, clinical ethicist, nurse motivator, and hospital janitor, all at the same time. Lack of sleep, lack of peace, lack of human contact, lack of food, and lack of encouragement, takes its toll. You can’t concentrate when you try to work, and you can’t sleep when you have the opportunity, because your brain won’t stop working. In the step-down facility you’re there 24 hours a day. In the CCU, you’re making three trips a day.

My loved one has been ill more seriously and longer than any of us are probably aware. She’s struggled with weight-related issues, endometrial cancer, circulatory problems, and pulmonary issues. She was more than likely dealing with COPD, and some form of Pneumonia before she contracted the bug that broke the patient’s back.

Enter the flu. From listening to doctors and nurses, I know that most people who die from the flu, usually don’t actually die from the flu. The flu saps up all of the energy and immunity, leaving any pre-existing or opportunistic condition to run rampant, unimpeded. It’s the secondary illnesses that get you. That is what happened to my loved one. She contracted the flu, which sapped her already compromised immunity, which in turn allowed pneumonia and other infections to turn into a somatic forest fire..

The Emotional Roller Coaster of Critical Illness

I have gone back on Facebook and noted the posts from her husband as she began her unwanted journey.

Dec. 14, 2013- “At the Doc with _______. Temp of 103.1 this AM. Tylenol brought it down to 100.8. O2 was in the low 80’s (on 2lpm /nc now) and up to 88. Might mean a trip to the ER. No evidence of pneumonia though and negative for Flu.”

He got her in to see the doctor, who immediately sent her to Memorial Hospital in Chattanooga.

“So the DX is back on __________. Pneumonia and some other condition?? that has caused them to do CPK~MB’s 4 times now and put her on a Heparin drip. Prayers would be greatly appreciated.”

Dec. 16, form my wife’s wall: “I don’t ask for prayers on Facebook too much but would appreciate some for my sis in law ______. She is in Memorial right now with Influenza A, the nasty flu, pneumonia, and some other not so good things going on. I know ________ is worn out and would appreciate prayers as well.”

My B-inlaws wall: “Being transferred to the cardiac care unit. Waiting on a bed.”

Later the same day: “So it got worse. Being intubated r/t respiratory failure. Critical labs, high risk for more nastiness ahead. The dominoes keep falling. Going to be admitted to ICU. Kills me that she said “please just get me out of here” and “please don’t leave me” as they were pushing me out. Sometimes life sucks.”

And later: “Intubation successful. Next domino is renal function at 40%, but heart rate is down from 125 to 95 and she’s not having to fight to breathe. Now comes the next battle to cure the multi-bacterial infections. Blood cultures back tomorrow to get a better picture. IV Azithromax and Rocephin are useless as M&M’s at this point.”

Dec. 17, B-inlaws wall: “So first off, I am so grateful for everyone’s prayers._________ is still sedated and intubated. Docs had me agree today to a tracheotomy and vent when she is out of danger from infections. Say she is stable but critical. Having a little difficulty keeping heart rate down. Thought she was coming out of sedation, so the increased the Diprivan. Had been in the 140’s. Now in the one teens . Only let me see her 4 hrs a day. Won’t let me in when they arouse her to check her functioning hand grips, eye blinks, etc. ’cause they tell me she might have a bad time with it. Keep praying, and thank you all so much.”

From Dec. 18th:_______ is stable this morning. Very wet lung sounds. Labs are midline and infections still raging. They stopped the Diprivan so I could talk to her. She opened her eyes and was able to nod and shake her head for yes and no. She understood about what was happening. She wants to get better. She hurts all over, but pain can be a friend too. Having no feeling would be bad. The Doctors are about ready to do the trach and vent. She would be less sedated unless she had anxiety issues. I told her I was agreeing to the trach and vent and she nodded her head yes. God’s grace and faithfulness are beyond my comprehension. Her nurse this morning, Ariel, is going for his masters and specializes in ______’s type of multiple complications. He Is going to give her sedation vacations for the next times I’m in the room so we can spend time together. She was calm and handled it as well as could be expected. We are still deep in the woods with a long, long path to travel. Please continue your prayers, for her in general and then specifically that her lungs would clear and that her respiratory failure would resolve. Please know that I love you all and believe that your faithfulness in praying is what is getting us through this.”

Dec. 19: “So, the word of the day seems to be “uneventful”. From where we were, Uneventful is good. Tomorrow at 4 PM the trach goes in. The Doctor had to give me all the information and negative potentials because of informed consent. I know what they are, but it’s just like the Miranda law: if they don’t say it, it doesn’t count. What the people here in the waiting rooms need, myself included, is hope along with the facts. I’ve been talking to some folks who are alone, no other support here. One man in particular whose wife (67) was brought in Monday with a similar situation to ______’s. He kept saying “I don’t understand what they are telling me”. I did my best to simplify, not really caring so much if I was overstepping my bounds (we all know what a know-it-all reputation I have). Last night the man thanked me and said he understood what the doctor told him yesterday and understands what he can expect. SO, if God can use my bent toward being a know-it-all to give even one person peace, I feel He can forgive the occasional stuffiness. 
For my sweet ________,  I know she hears me, because her pulse changes. My sister__________saw evidence of that last night. So what us next? We wait and we keep praying. Thank you all so much again.”

Later on the 19: “They have reduced _________  propofol from 50 to 25 mcg/kg/min. She opened her eyes once and responded to my saying I was there. Her hands are gloved, but she is a strong woman. I told her to relax and tomorrow was going to be better. She swallowed twice and tried to visibly relax. This better go well. I don’t need more non-fun happening. Keep praying.And thank you all.”

Dec. 20: “Today is a big day. Tube out, trach in. The first visit of the day is always scary. Gonna be glad to have her off sedation when today is over. Not gonna think about anything but all the positives ahead. 6 minutes til I see her. Thanks for your continued prayers.”

Later on the 20th: “It’s after 6 and no word yet.________’s surgery could have started late. Trying to find something to do to keep from running up the walls. Have puzzle book, thanks to _____________, have you guys, my sister____________, and Eric Adams are keeping me company, and I have my faith. Maybe I should have learned to roller blade.”

And later:_________ is Out of surgery. Lungs collapse a bit, but airway establish. Dr Hunt says she looks much more comfortable. Don’t know if out of sedation at 8:30-9:30 visitation time. May have to wait until tomorrow. Thank you all so much and please keep praying for her continued healing.”

Dec. 21: “Citrobacter Amalonaticus is one if the little devils. It seems to be very nasty and decided when the flu hit it would join the party. Labs slowly returning to normal. Doc says she’s changing __________’s type of sedative so she be more awake. It’s a process and a long road. I appreciate you guys traveling it with us.”

After the tracheotomy, on the 21st: “Goodbye Propofol, hello Precedex. Lighter sedation. Was awake and acknowledged me. Very weak. Infection still raging insanely. Gonna have to figure out communication. She understands me, but I’m having to learn Greek. I did that once and it was tough. As __________ gets stronger things will become easier. For now I am happy for the few moments between the many minutes. Keep believing with me. God bless you all.”

Later on the same day: “Back with ________again. My mom and dad, _______ and _________, my sister ___________, and niece __________ are here with me. Labs still mostly good, but infections have caused temp to soar. 102.3 now but doc wants to see how high it will go without tmt; cutoff point of 102.5. Hello. Almost there. Bring on the Tylenol. Opened her eyes and acknowledged we are here. But so weak. I can’t even imagine. Please continue with us and lift my girl up in church tomorrow. Many thanks and God bless.”

Later, Dec. 21: “Okay. So call me bossy Betty. Told the nurse temp at 102.5 so we probably need to start the Tylenol. And elbow against the rail, on your next turn we can get that repositioned. And the BP readings were a little off but when you go back in you’ll see the cuff needs to be repositioned. Great. I’m becoming one of those family members. But I made sure to say thank you for all you are doing. Oh well. Love you guys.”

From my wall, on the 22nd: “______’s temp. Was down to 99.0 when I left. Her respiration was down to about 81 from 96 earlier in the week. They have reduced her sedation to .3 mg/hr. Her blood pressure was excellent. 

The best news of all is that she was responsive today, and even asked if they had done the tracheotomy. She also responded when the nurses told her about how many visitors she had. 

Another good sign- they had her ventilator set for 18 breaths per minute, but she was actually breathing 22 pet minute, which means she is attempting to breathe on her own, a very good sign. A good but exhausting day for both ______ and__________. — feeling confident.”

My B-inlaw on Dec. 22: “Going back to see___________ at 8:30. She has improved since last I posted. Vitals normalizing. Temp 98.8, albeit with cooling blanket and fans in place. Weaning off Precedex so will be on prn sedative tonight. She roused enough to ask the nurse if she was trached. Propofol and short-term memory aren’t buddies, so it’s gonna be a shock when she is awake enough to realize everything. Vent still 45% O2, but hoping with improvements we can slowly wean. Still way over 17 on WBC’s. Waiting on culture of picc line. Still deep in the woods, but we see one of those boy scout trail markers saying “It’s that way”. Much, much appreciation for your continued concern and prayer as we search for the clearing. You guys are great. God bless you and thank you for your belief and graciousness.”

Later the same day: “So now the good news. _________ was awake and alert. Had no idea what had happened or how long. Thought she had missed Christmas. When I told her about what all of you have done and the prayers thoughts, wishes and love you’ve sent, she beamed. You guys have made what started out as a scary day into something wonderful and I cannot express my gratitude. Gonna start Levophed to see if we can’t get the low Mean Arterial Pressure (in the 50’s) back to a safe level. God bless and good night.”

From my wife’s wall on the 25th: “Merry Christmas! Hope all my friends have a wonderful big happy Christmas! I am surrounded by my family, watching _________ work diligently to figure out my new phone, as I type this on my brand new Laptop, kids all exhausted from opening gifts and now chilling out! Fixing to head to _______ Hospital to see _______ and ________and spread some Christmas cheer!”

From my daughter’s wall on Christmas Day: “Spending time with __________  for Christmas! Hoping to brighten up her room a little with presents and notes and flowers:) “

My B-inlaw on the 30th: “As I sit at___________ Hospital with __________, I recall a time when _____ and _____________ served at our church in Ft Oglethorpe, Ga. One particular sermon spoke of pillars and caterpillars. The pillars helped support the church, the caterpillars just crawled in and out every week. The same is true in nursing. A burned out nurse is like the caterpillar, crawling in and out on routine, no passion, no urging of their call to help others heal. Pray that God will rejuvenate and rekindle the first love that nurses require to serve others; and pray that God will crop dust those in their care with the blood of Jesus to protect and heal until a fire of passion is rekindled in the hearts of those who, through overwork, understaffing, and stress have lost the love for their calling.”

You can follow the ups and downs of our current crisis. I am recording this on my blog so my family can have a single place to go to work back through this emotional roller coaster. Making sense of all of this is going to take a strong faith, an informed faith, and a reasonable faith. I will continue the more personal details a couple of posts from now.

Think First, Then Feel

For now, think about your family. Think about facing some very critical ethical issues. If you are a Christian, think about the grid you will use to prepare for a difficult moment, maybe a decision that will mean the end of someone’s life, and who will decide. How will you decide? How much will you depend on the medical community for that decision? How much will you depend on your Pastor, or fellow church members? How much will you depend on family and friends for advice? How much will you depend on a sound Biblical worldview rooted in Scripture, and the historic Christian faith? Does your worldview mater? Soes the worldview of the doctor, hospital, and government matter? We will probe these things together in future posts. I don’t have any easy answers. I don’t know that there are easy answers to these types of questions. We will approach them nonetheless. 

My next post will be more theological, but I wanted to record the ups and downs of my loved ones, so you know that these issues are not theoretical. I also want my family members to have a written record of our painful trek.

Thank you for your time.

simul iustus et peccator, 

Eric Adams 
Rossville, GA 

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