death, dying, and being an intern

I've had the "worse" months of intern year frontloaded and I can finally see the sun rising over the horizon.  I've had way too many goals of care discussions with families that are really emotional for everyone involved and that's been exhausting for everone.

I've had so many patients who have their prognosis described to them objectively by no less than 3 teams of experts from different specialties and the patient and family still want all heroic measures taken.

Many times the patient gets so sick and requiring so much medicine that they can't make decisions on their own, or their so elderly with severe dementia.  I've seen family members decide that it's somehow better for that family member to get a tracheostomy so they can stay connected to a ventilator and stay "living" when that patient can't even interact with them anymore.

I do my best by explaining what "full code" means to families and patients, and how it isn't a magic intervention without side effects like anoxic brain injury or becoming dialysis dependent from circulatory shock.  I'm also a little disappointed by neurology teams who have given families unrealistic prognoses.

I tell people CPR breaks ribs, can cause pneumothoraces, patients end up requiring ventilator support and sedation and dialysis, all because their body is too weak to run it's own life supporting processes.

I've seen way too many people die on ventilators in the middle of the night when their families aren't around.

I can tell you I don't want a tracheostomy and I don't want to be full code if I'm in my 80s with an incurable illness.  I want a good quality of my life for the remainder of my life.  At home.  With family.

Not in some dark hospital coding overnight, sedated on a ventilator with people lining up to crush my chest with chest compressions and then surgery getting paged to throw a chest tube in me and dying unable to interact with the world.

Life is a warm and beautiful thing.  There's nothing wrong with hospice or comfort care and passing away at your home.