condolences to pascale
Pascale Lane, a twitterverse friend of the mudphudder’s, recently lost her cat, Denver the wondercat, after 18 years. My condolences to Pascale. Not too long ago, I lost my cat after 17 years. It was heartbreaking. I couldn’t remember a time, extending back to my youth, when I was without my cat. And then he died.
While for cynical me the experience was just another reminder of how cruel life can be and that everything good eventually comes to an end, Pascale has chosen to take a more practical approach and attempts to extract something useful from her experience as she reminds us that while Denver the wondercat died peacefully in his sleep, many people do not have that luxury and that we should specify advanced directives and/or discuss these end of life issues (e.g. whether to have life support–CPR, intubation, etc.) with our doctors ahead of time. This is, of course, a hot topic item in light of recent health care reform discussions and the fact that Medicare does not cover the cost for patients to meet with their physicians to have such discussions. I say “of course” but of course I have minimal insight on the matter as I spend most of my time as an intern and only recently found out that there even was a health care reform discussion.
But I digress. Pascale, you are so practical. Time to grieve but I understand. So in a show of solidarity and in support of Pascale as well as toward a lasting legacy of Denver the wondercat if we can get even one person to plan ahead, I too will make the pitch. However, I am not quite as warm and fuzzy as Pascale so I will do it in my own cynical, bitter way.
Here’s why people need to have these discussions. 1) Because they can and 2) because I don’t want to be the one making these decisions.
I always feel especially bad when intelligent animals die. They know and understand so much, and yet my feeling is that in the end they don’t really have an understanding of what’s about to happen. In fact I don’t know that they have any understanding of death at all (note: animal people, DO NOT send me emails about how this species or that species does understand death–I’m speaking in generalities here). Anyway, maybe that’s all for the best. My cat understood health and life and enjoyed both. You could tell from his reaction to illness and how he would seek out help from us when he was previously ill. But at the end, I don’t think he understood the untreatable nature of his demise. That was the hardest part for me to deal with. He wanted help–you could tell–but there was nothing to be done. I suspect it was similar with Denver the wondercat. My suspicion is that if my cat or Denver had understood the impending end of the road, they would have made plans and requests in terms of how to be cared for at the end to best suit their comfort needs. Cats are very responsible and self-centered in that way. Of course we tried our best, but one never knows. Only the cat did.
Now, with people it’s a different story. From about the time we’re 4 years old we know and understand that we will die. It sucks but there’s no escaping it. It’s like the direct admission that comes in 2 minutes before my shift is up every night–the one that keeps me there 3 hours past when I was supposed to go home. It’s inevitable. I pray that it won’t, bargain with God or Admitting (one and the same sometimes) but sure enough that direct admit will show up just as I am about to go home.
So people have no excuse. Don’t people want to be prepared for the end? Is it carelessness or a selfish need to avoid an unpleasant truth? In either case it’s plain irresponsible. Plus, people are largely responsible for their own deaths. Yeah, you, the dude who’s eating a big mac while reading this, I’m talking to you. And I’m talking to me because I too am eating a big mac while writing this. But seriously, when you think of the major causes of death, many of them are preventable (for the most part). Heart disease, cancer (some types, e.g. lung), accidents, diabetes (type II), etc. I don’t personally have any of these problems but I definitely see myself working towards at least 3 if not all 4. In any case, we’re all killing ourselves slowly, so we might as well be prepared for when it happens. Death is not a dignified process–better to make it as painless and orderly as possible.
Which brings me to my next point. I don’t want to be the one who has to make these decisions for you. A lot of disorder and chaos is ensues when a patient codes and family members are arguing back and forth over how far to take the resuscitation effort. It’s no good. A doctor is always going to err on the side of saving a patient if advanced directives are not clear but I don’t think any doctor wants to put a patient through a lot of possible pain and discomfort during resuscitation if it’s not the patient’s wishes. I don’t know, call us selfish or whatever, but we’d rather you made up your own mind. You know what I’m saying?
In any case, Pascale brings up a good point. Think about it people and tell others to think about it too.
Pascale, feel better my friend.