Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


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Tuesday, May 8, 2012

HCR -- Another Death with Dignity Story

By John Ballard


The narrative is from Kevin, MD by Dr. Dike Drummond. 


The music and video is background for reading. If the reader finds it distracting, don't play it. I think it seems appropriate. 




The ambulance crew rolled him into my ER breathless in his pajamas, O2 mask on his face, gasping for air, his short cropped hair a mess, standing straight up. Eugene was what the staff called a �frequent flyer.� As the nurse injected some IV Lasix I reviewed his chart to find a classic downward spiral.


It was a busy evening. The bays were full of the usual cuts, broken bones and chest pains, the waiting room with snotty noses and chronic pain patients hoping for a refill from the new kid in town. I was a freshly minted family practice doctor taking a year after residency in this rural California emergency room to take a break, get some experience and make a little money.


I came to call this �a MASH Unit in reverse.� We had no on-site surgery. It was my job to keep the life threatening cases alive until the helicopter arrived to take them to the trauma center a 40 minute flight to the south. In MASH they flew the wounded in. Here my job was to keep them alive until we could fly them out.


I had vowed that no one would die in my Emergency Room if I could help it. Until I met Eugene and Mary Ann.


She was a stark contrast to Eugene. Looked like she had just finished dressing to go to church on Sunday morning: immaculately pressed with perfect hair and her knitting in hand. She had obviously been here before. It was clear from the first second I laid eyes on her that she adored her husband of 56 years. Despite the mask and the respiratory distress, I could see the same love for her in the old man�s eyes.


This was his 6th visit to the ER in the last 18 months. He had a bad heart and it didn�t take much to throw him into pulmonary edema despite 14 pills and over $200/month in medication. On a good visit he spent 4 days in the hospital getting his meds adjusted. On a bad visit he was on the ventilator for 3 days and in the hospital for 10. Each time he emerged weaker. Lately he was wheelchair bound and Mary Ann had learned to deal with adult diapers and getting him around the house. This would be one of the good visits.


I sat down with them once his breathing was easier and asked, �How are you feeling about the quality of your life lately?� Mary Ann wiped some tears as Eugene told me how miserable he was, how much he hated being a burden and what a good life he and his wife had in days past.


None of us said anything for a while. Mary Ann set her knitting aside and sat as close as she could to the bed. They held hands � as the nurses said they always did.


�We can keep giving you medicine and even putting you on the breathing machine if you want, and here is what I am afraid of. It is only a matter of time before you won�t be able to get off that machine. When that happens Mary Ann will be faced with the decision of whether or not she tells the doctors to turn the machine off. I am pretty sure none of us want to put her in that position if it can be avoided. It sounds like you have been pretty miserable lately and you are getting weaker as time goes by.


I want you to know that each time you come in on the Ambulance is potentially the natural end of your life. We are stopping that with our medicines. If the two of you want, we don�t have to do that. If you two have a discussion and decide you would like the next time you come in to be the natural end of your life, and I am in the ER when you come in, I can help that happen for you.�


He was breathing easier. We switched him to the nasal cannula and his sats held. I left the room and let them talk about this new option for a few minutes.


When I returned she was standing by the bed. Eugene spoke. �We want you to help us do that doctor.� I looked them in the eyes and nodded. Both of them were crying in a way that I knew the foundation for their emotions was love � the love everyone sensed when in their presence.


I had them fill out his Living Will and No Code paperwork. Everyone wished them well as they were wheeled to the medical ward. Before the end of the shift I huddled with the staff and told them the plan, secretly hoping � and dreading � I would be on staff the next time.


6 weeks later, at 10PM on a Saturday shift, the call came in. Eugene was on his way. Severe respiratory distress. Rales to the apices. O2 mask in place.


We wheeled him into the room with Mary Ann holding his hand. Eugene was barely able to maintain his consciousness, panting with blue lips. They immediately recognized me. I looked at each in turn. They both nodded and quickly looked away. I gathered the staff and told them what we were not going to do, pulled the curtains around the bed, and held Mary Ann�s free hand.


The noises of the ER receded to a background hum. Mary Ann stroked his forehead as his breathing worsened. She gripped my hand, looking up to me from time to time.


It only took 10 minutes for Eugene to die. At the point of his last breath � we witnessed his passing � that span of seconds when we could sense his spirit leaving, almost see it happening. Joy, memories, love, grief, pain, longing for more time, relief that it was finally over, the last goodbye, filled the room.


Mary Ann was so happy, so sad, so intensely remembering all they had shared. We hugged. She thanked me and everyone on the staff.


I stepped out into the full blast of the sights, smells and sounds of my next patient and the remaining 10 hours of my shift.


Eugene was the only patient I lost in the ER that year.



Music Lyrics link



2 comments:

  1. I remember ten years ago when I signed the do not resuscitate order for my father - it was a real bitch. I was told he would die within 24 hours but he was a tough old bird and it was 6 days of hell for us and in spite of the morphine drip I'm sure it was hell for him. That changed my life and my attitudes on death. I came to realize that death is not the worst thing that can happen to you. There is a hell but it's not a biblical one but the one we create here on earth with the help of the medical industrial complex.

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  2. You are so right. Most people don't have any idea how tough the will and ability to live can be, often when we want to see death come quickly.
    A few years ago when my father's brother had a massive stroke he was in the hospital for the first time in his life at the age of 82. It was clear that stroke activity had wrecked both sides of his brain leaving him comatose. The family wisely decided for a DNR order and his breathing and heartbeat continued for sixteen days without food or hydration. Fortunately he appeared to be in no discomfort, lying there as though he were asleep until the end came.
    Of all the issues we discuss, the one with truly universal relevance is that of dying. Watching it happen to someone else may not be universal, but having it happen to ourselves is one hundred percent certain. Here is a link to a good palliative care story.
    http://www.newshoggers.com/blog/2011/06/hcr-palliative-care-story.html
    And here is a link to a list of advance directives for different states. I'm not at my main PC (this one is not pdf capable) and have not checked it out, but it looks comprehensive.
    http://www.noah-health.org/en/rights/endoflife/adforms.html

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