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Sunday, December 23, 2012

Putting a pet down and end-of-life care decisions

Two things about this post before I go on:
1) It may be a bit heavy for the holidays, and
2) I promise that the two things in the title are related.

I have 15-year-old Siberian Husky that's had its fair share of health problems: diabetes, cataract surgery, liver cancer, debilitating arthritis...you get the point. She's old. My mom refuses to put her down. Like, we have made appointments with the vet and at the last minute she'll change her mind and not allow us to take the dog.

My dog in old, but better, years.

But the thing is, the dog needs to go and I say this in the most compassionate and sorrowful way I can convey over the internet. She can't stand for more than a minute. She has trouble standing up at all and makes it about 4 steps on average before falling over (not sitting down...I literally mean falling over, often onto her side). We have to hold her up so she can pee and often she soils herself before we can get her outside. In short, it's her time to go. And I wholeheartedly believe that we'd be doing the right thing by putting her down. Mom thinks the opposite and refuses to budge.

How does this relate to medicine and more importantly, human medicine? Well, it seems to me that the feelings toward extending someone's or something's life are reversed here as compared to how these decisions are regularly made.

I have been in healthcare for a while and I've seen relatives insist on keeping their elderly parent alive at all costs even when the patient's quality of life is non-existent. Usually these relatives are detached from direct care of the patient either due to distance or lack of relationship, and simply cannot bear the thought of losing the patient because they "want more time."

Usually this request to keep the patient alive is due to their guilt about not spending enough time with their loved ones in the years leading up to the illness, and thus they feel like they need to extend the parent's life as long as possible to squeeze in the time they've missed.

On the other hand, the caretakers and/or the family members who see the patient on a regular basis watch the suffering and decline of their loved one and thus are better able to come to terms with the end of their parent's life. In fact, in some cases death is seen as a relief and a thing that some people wish upon their loved one simply to end their suffering.

All of this is a gross oversimplification of an abundance of end-of-life issues and this scenario is not always the case, obviously. But if a trend can be attached to this stage of one's life, then this would be it.

However, it seems that the roles are reversed in my family. My mom, who does nearly all of the care-taking, insists on keeping my dog alive until she dies on her own (not happening any time soon, from what I can tell) even if that means she lives a miserable existence until then. On the other hand, my brother and I, who both live several states away and rarely see the dog these days, are completely okay with putting her down.

This does not mean we want to get rid of her by any means. I wish she could live forever, but unfortunately at this point in her life she has absolutely no quality of life, seems to suffer through her days, and gets no joy out of anything that happens around her. In the several weeks I've spent with her between October and today, I haven't seen her wag her tail once or show any interest in the delicious meaty dishes we cook up every day. She used to run/meander to the kitchen from the front yard as recently as June, so this is totally out of character and a good indication of the loss of her personality.

I know that putting a pet down does not compare to saying goodbye to a mother or a father, or any human member of one's family. But this dog situation and the family dynamics surrounding it have got me thinking about the human aspect of these issues.

I am a huge proponent of ceasing medical interventions at the request of the patient at a certain point in their care and letting them die with dignity and on their own terms when it becomes clear that they are terminally ill (which translates to putting a pet down in the animal world). This does not mean I advocate euthanasia but I definitely think hospice has a great role to play in patient care and it needs to be considered as an option more often than it is currently.

This situation has also started a discussion within my family about what we want others to do for us when we reach that point in our lives. That, and writing about it all helps take away some of the anger and helplessness I feel about watching my dog suffer unnecessarily.

Lastly, there are more complicated issues surrounding my mom's resistance to putting my dog down than what I have included here. I don't agree with them, but they exist. Regardless, I don't want this to become a discussion (between my three readers and me) about my mom's decisions or what we should do in this situation. We've discussed it ad nauseum and I really don't want to hear about it anymore.

Other than that, discuss away and happy holidays!

Dirty camping dog, at age 13.

Saturday, December 15, 2012

Emergencies on airplanes

I've slowly been writing about my experiences over the summer and the following occurred on one of my flights. This post was originally written in response to a thread about helping in medical emergencies as a doctor and if such interventions make a difference in patient outcomes:

About half an hour into the flight they asked for a doctor, nurse, or anyone with medical experience. A little while later the plane took a hard left to divert for "an unexpected landing" as they called it.

(This was a foreign airline so most announcements were in a language I didn't understand with English translations lasting a fraction of the original announcement. So I only have a bare-bones understanding of what really occurred.)

Either no one was available to help or no one volunteered because the flight attendants were the only ones providing medical care to the passenger. I was asleep and awoke to the sudden turn and "unexpected landing" announcement, which scared the crap out of me because I thought we were going down, until I saw the oxygen tank attached to an unconscious dude being carried down the aisle.

All in all, I don't think a doctor or medical professional would've changed the outcome for the passenger since the guy was hooked up to an AED ("No shock advised" numerous times) and CPR was being performed with an hour still left to our emergency landing (we were over water). At that point, the flight attendants were doing all that could be done with the limited resources found aboard an airplane and more training on their end wouldn't have made a difference.

I'm applying to med school now thus I'm not a doctor but I've been in EMS for 6 years so I'm familiar with emergencies in weird places. I like to think I would've volunteered had I been awake and no one else had been available. But I don't know.

What's worse is that the guy didn't suddenly die. He had some sort of medical emergency that eventually led to cardiac arrest so maybe even my basic assessment could've helped him in some way. And had this happened on land, with the 30 minute lag between the first signs of medical trouble and cardiac arrest, he maybe would've made it.

But since we were airborne, there's really not much anyone could've done in that situation with such few supplies and such a long transit/landing time to higher level care.

In short, a plane over water is most definitely the worst place to have any kind of medical emergency.

Wednesday, December 12, 2012

Stressing out

I promised myself I wouldn't be one of those neurotic pre-meds during the application cycle but I've turned into an unrecognizable ball of stress. I'm riling myself up to the point of getting sick days before my next interview, and I absolutely NEVER get sick normally. I didn't even fall ill in the days leading up to the MCAT. And I stayed healthy while waiting to get my MCAT scores when I was pretty sure I had scored sub-30, which would have been the death of my chances to get into medical school this cycle.

Not hearing back from my dream school when I know a good chunk of others have already gotten in is the source of most of this stress. I know they will continue reviewing my file until March but if they didn't love me this time, what's going to change between now and then? I have nothing more to give.

It also doesn't help that at this point I thoroughly believe I bombed the interview. Every time I go over the answers I gave, the worse they seem to be. Or at least only the low points stick out in my mind right now. Maybe I should've smiled more throughout the day (I remember being exhausted), or channeled my enthusiasm towards "Why medicine?" instead of only perking up at the mention of broomball (and the prospect of an ethics question...I did get visibly excited when that came up). Or perhaps I should not have challenged my interviewer with an emphatic, "I know." But I really did know, and it seemed like the appropriate response at the time.

I like to worry and work myself up about things. Take this and this and this and this as examples, and I can provide many more. I used to be really good about letting things go but I feel like my admission into this school is still somewhat within my control. And that's why I just can't ignore the silence and simply wait for some form of communication from them. I feel like I need to DO something.

In addition to all that, not only do I REALLY want to get into this school, but it's also the only one at which I have a decent chance of getting into. I've only received two interview offers total this application season (thus far, of course, but it doesn't look like any more are coming along) and the other school is very hard to get into as an out-of-state applicant. So if I can't get into my local school, who else is going to take me? The thought of going through this again is absolutely sickening.

Honestly, I don't know what the point of this post is, besides maybe to vent. But writing this all out has helped me realize that I really need to chill out and enjoy this year off, because it'll be a while until I have this much free time again.

And in that respect, I really have taken preventative measures to minimize thinking about this process. I've blocked the friends who are also applying this cycle from my Facebook feed, I've cut myself off from SDN (again), and I've told my family not to mention medical school applications to me even just to inquire about how it's going. I'll update them if/when something changes.

The final step is finding a new hobby that will take an inordinate amount of time and has nothing to do with medicine whatsoever. Underwater basket-weaving, perhaps?

Tuesday, December 11, 2012

No news and interviews

Birthday week has come and gone and still no news. I'm sure you figured that out from my silence because I would've announced an admission to the world. I guess that post will have to wait for another day.

That's not to say I have an admissions post written by any means. I am not that ahead of myself. Right now I'm brainstorming a letter of intent to my dream school in case it comes to that.

Speaking of the dream school, I'm pretty sure the admissions committee met sometime last week because my status on their website changed during that time instead of directly after my interview like it normally does. I'm still not too concerned because few people get in during the first post-interview committee meeting or even the second, with most people hearing back in late February/early March. I really don't care when I hear back from them, although the sooner the better. I just hope I get in at some point this cycle.

Anywhos, for now I need to focus on my upcoming interview and get prepped for it like I was for the last one. I will let you know in vague detail how that one went when I get back from it.

Monday, December 3, 2012

Birthday week news?

I have this weird feeling (or is it a hope?) that I will get tremendously awesome news on my birthday this week. It's happened before with a job offer so I'm not completely going crazy, I swear.

The admissions committee for the school I interviewed with last month supposedly meets sometime in the next couple of days and not only do they email acceptances but the dean of admissions also calls each accepted student.

So my secret hope is that he realizes it's my birthday this week and waits to call me with great news on that particular day.

One can dream, right?