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MY GRANDMOTHER was in her late eighties when she suffered a heart attack. She was rushed to hospital; she had to be heroically resuscitated in the ambulance.
Two days later, I went to the hospital to see her. We had never been close, and she was not your bog-standard cuddles-and-cupcakes granny – in fact, until that moment, I don’t think she and I had ever shared anything on an emotional level.
But as I asked her how she was, she looked at me with tired eyes and said: “Why did they do that? Why?”
It took her weeks to recover; by the time she left hospital, her leg muscles had wasted, she was confined to a wheelchair, and subject to a number of the other indignities of failing flesh.
I’ve thought about that revealing moment often over the years, and it has been in my mind now as we’ve been watching and hoping and praying for Madiba.
Let’s take this out of the realm of what’s been happening in real life, and look at it hypothetically. We are able to keep someone alive for so long now, with all the wonders of modern technology, but is it right?
Is it right to keep a very old person from slipping gently out of life – simply because we can? Are we required by some sort of moral imperative to use every piece of equipment we have in our medical armamentarium? How do we weigh up the value of the extension of life against the unknown suffering of the person on life support?
As I write this, news sources are quoting ANC MP Nkosi Patekile Holomisa, president of the Congress of Traditional Leaders of South, as saying: “If Madiba is no longer enjoying life and is basically on life-support systems and therefore is not appreciative of what is happening, I think the good Lord should take a decision to put him out of his suffering.”
It’s up to God to make that decision, he apparently added.
But it’s not. I wish it was, but in the end, it’s up to human beings. And the thing is, the human race, this bunch of jumped-up primates, keeps getting cleverer and cleverer. We can do ever more to stave off the moment when the heart, the lungs and the brain stop.
It’s getting more and more difficult to decide when life ends – severely injured people in whom virtually all brain activity has ceased can be kept alive on machines that pump their hearts for them and do their breathing for them.
Is that life?
Yet doctors feel impelled to do whatever is possible, whatever the medical scheme will bear. (And just being pragmatic here: cutting-edge end-of-life care can be cripplingly expensive, and there is a limit to what even the best scheme will cover.)
Quite often it’s the patient’s family who insist on ‘full code’, as the Americans call it: should the patient start to slip away, they want doctors and nurses in every corner of the room, doing CPR and pumping up the meds.
As a doctor once said to me, “It’s become a case of ‘keep the patient alive at all costs’; sometimes I feel it’s the patient who pays the cost in suffering”.
In his 2009 Washington Post article, The Dying of the Light, Dr Craig Bowden wrote: “Among the patient-care team – nurses, physicians, nursing assistants, physical and occupational therapists, etc – there is often a palpable sense of ‘What in the world are we doing to this patient?’ That's ‘to’ and not ‘for’.”
“We all stagger under the weight of feeling complicit in a patient's torture…” And torture it can be: “Everyone wants to grow old and die in his or her sleep, but the truth is that most of us will die in pieces.
"Most will be nibbled to death by piranhas, and the piranhas of senescence are wearing some very dull dentures. It can be a torturously slow process, with an undeniable end, and our instinct shouldn't be to prolong it.”
That’s why I think we have to talk, as families, and as nations, about what we really want out of our medical system.
I want quality of life, along with quantity if possible; but if the quality runs out, I don’t want to burden the healthcare system with demands for all the cutting-edge treatment that can be thrown at me.
I also don’t want my family to have to mortgage their homes to pay for what’s not covered by my medical scheme. And I certainly don’t want to be nibbled to death, piece by agonising piece.
As a nation, and as the healthcare industry, I’d like us to be thinking about what we can offer that would extend quality of life – real palliative care for those nearing the end.
A combination of the kind of treatment that will make the patient comfortable and happy instead of invasive treatment aimed at simply keeping the lungs pumping air, and the kind of environment that will allow people to be peaceful, to see familiar and loving faces, to say the goodbyes that they want to say, to ‘go well’.
Can we offer that, within the current paradigm of healthcare? Could we offer anything remotely like it in the state system?
It would be worth dedicating some of our funds for research and facilities to ensuring our people - you and me - die good deaths, I think.
- Fin24
*Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own.
Two days later, I went to the hospital to see her. We had never been close, and she was not your bog-standard cuddles-and-cupcakes granny – in fact, until that moment, I don’t think she and I had ever shared anything on an emotional level.
But as I asked her how she was, she looked at me with tired eyes and said: “Why did they do that? Why?”
It took her weeks to recover; by the time she left hospital, her leg muscles had wasted, she was confined to a wheelchair, and subject to a number of the other indignities of failing flesh.
I’ve thought about that revealing moment often over the years, and it has been in my mind now as we’ve been watching and hoping and praying for Madiba.
Let’s take this out of the realm of what’s been happening in real life, and look at it hypothetically. We are able to keep someone alive for so long now, with all the wonders of modern technology, but is it right?
Is it right to keep a very old person from slipping gently out of life – simply because we can? Are we required by some sort of moral imperative to use every piece of equipment we have in our medical armamentarium? How do we weigh up the value of the extension of life against the unknown suffering of the person on life support?
As I write this, news sources are quoting ANC MP Nkosi Patekile Holomisa, president of the Congress of Traditional Leaders of South, as saying: “If Madiba is no longer enjoying life and is basically on life-support systems and therefore is not appreciative of what is happening, I think the good Lord should take a decision to put him out of his suffering.”
It’s up to God to make that decision, he apparently added.
But it’s not. I wish it was, but in the end, it’s up to human beings. And the thing is, the human race, this bunch of jumped-up primates, keeps getting cleverer and cleverer. We can do ever more to stave off the moment when the heart, the lungs and the brain stop.
It’s getting more and more difficult to decide when life ends – severely injured people in whom virtually all brain activity has ceased can be kept alive on machines that pump their hearts for them and do their breathing for them.
Is that life?
Yet doctors feel impelled to do whatever is possible, whatever the medical scheme will bear. (And just being pragmatic here: cutting-edge end-of-life care can be cripplingly expensive, and there is a limit to what even the best scheme will cover.)
Quite often it’s the patient’s family who insist on ‘full code’, as the Americans call it: should the patient start to slip away, they want doctors and nurses in every corner of the room, doing CPR and pumping up the meds.
As a doctor once said to me, “It’s become a case of ‘keep the patient alive at all costs’; sometimes I feel it’s the patient who pays the cost in suffering”.
In his 2009 Washington Post article, The Dying of the Light, Dr Craig Bowden wrote: “Among the patient-care team – nurses, physicians, nursing assistants, physical and occupational therapists, etc – there is often a palpable sense of ‘What in the world are we doing to this patient?’ That's ‘to’ and not ‘for’.”
“We all stagger under the weight of feeling complicit in a patient's torture…” And torture it can be: “Everyone wants to grow old and die in his or her sleep, but the truth is that most of us will die in pieces.
"Most will be nibbled to death by piranhas, and the piranhas of senescence are wearing some very dull dentures. It can be a torturously slow process, with an undeniable end, and our instinct shouldn't be to prolong it.”
That’s why I think we have to talk, as families, and as nations, about what we really want out of our medical system.
I want quality of life, along with quantity if possible; but if the quality runs out, I don’t want to burden the healthcare system with demands for all the cutting-edge treatment that can be thrown at me.
I also don’t want my family to have to mortgage their homes to pay for what’s not covered by my medical scheme. And I certainly don’t want to be nibbled to death, piece by agonising piece.
As a nation, and as the healthcare industry, I’d like us to be thinking about what we can offer that would extend quality of life – real palliative care for those nearing the end.
A combination of the kind of treatment that will make the patient comfortable and happy instead of invasive treatment aimed at simply keeping the lungs pumping air, and the kind of environment that will allow people to be peaceful, to see familiar and loving faces, to say the goodbyes that they want to say, to ‘go well’.
Can we offer that, within the current paradigm of healthcare? Could we offer anything remotely like it in the state system?
It would be worth dedicating some of our funds for research and facilities to ensuring our people - you and me - die good deaths, I think.
- Fin24
*Mandi Smallhorne is a versatile journalist and editor. Views expressed are her own.
