Saturday, November 6, 2010

Bad/good dreams

The situation in my previous post caused me to have a dream last night I'm sure.  Last year I had a young man on my caseload who had an accident and then was put on life support and then I had to make the decision whether or not to remove the life support.  This was definitely the most stressful time of my entire working life.  I lost sleep over it and was a wreck for the entire time he was a live and for a period after his death.  He was only 24, he was a big tease and I quite enjoyed him.  What happened was he had a seizure and the way that he fell blocked his airway and when he was discovered they resuscitated him.  Then he was placed on life support.  Now I can't just decide to remove someone from life support.  I have to get a judge's approval and this of course doesn't happen lickity split.  So in the meantime a doctor asked if they could preform a tracheotomy to relieve pressure and provide more comfort to this young man.  I consented.  Biggest regret in my life.  What happened was that the young man then began to breathe on his own, due to reflex, and the ventilator was removed.  Still there was absolutely no brain activity.  So what do you do in this situation?  There is no plug to remove in this case, so to speak.  Well I relied on the professionals.  After knowing what I know now, I should have never consented to the trachea because then there would have been a plug to remove and the death would have been a lot quicker.  What happened was the young man starved to death.  He was given pain medication but no nutritional IV.  It took approximately a month for him to pass away.  I did go and see him in this state.  I felt I had to because of the decisions I had made lead him to this spot.  I had and still have an immense amount of guilt around this guys life and death.  I know that I made decisions based on what the professionals told me to do, however I don't know that I would do it the same way again, no I know I wouldn't.  Based on this experience my personal directive states I will not consent to resuscitation, or tracheotomy, or any plug being put in. TV glamorizes death when you take a person off of life support, it doesn't always happen in moments, sometimes it takes days or weeks for the person to pass away. 
Well last night I dreamt about the young man.  In my dream he started off in the bed, dying, and by the end of the dream he had recuperated and was full of life again.  The dream ended like I wish his life would have.  It doesn't get rid of my guilt, but I hope now that he is in peace and no longer in pain.

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