I had a personally gratifying encounter with a new patient in my office yesterday that I thought would be worth sharing. A petite 70 year old woman, she was sitting in my examination room for a consultation regarding a routing colonoscopy. [Yes, I do practice traditional gastroenterology with a holistic metaphysical bent]. She looked at me and asked if I remembered her. Often new patients will look familiar to me, but frequently they merely remind me of someone else. Having been wrong as many times as I have been right, I do not always inquire if we had met before.
She proceeded to describe an event that had occurred at least five years before. I had been called in consultation by her primary doctor with the intention of having a PEG [percutaneous endoscopic gastrostomy] tube inserted for feeding in her 95 year old mother with cancer. Now these are politically sticky situations for me since my practice depends upon referrals from primary doctors. Also, the practical aspects of the practice of medicine involves compensation for doing procedures, not for refusing to do them.
However, even then I ‘knew’ that this procedure made no sense whatsoever. I spoke with this same woman, the daughter, over the phone, I believe, and expressed my opinion that this procedure seemed inappropriate. Now believe me, I am extremely sensitive as to how I address these issues with families. I am deeply aware of how difficult these end-of-life issues can be. Emotions are severely strained and families are often frightened and confused. Their personal beliefs may be such that they would not forgive themselves if their loved-one died without such a tube.
In this case, however, the daughter actually agreed that her Mother should be allowed to die in peace, without the feeding tube. Her primary doctor, however, was insistent that it be done. He yelled at her, questioning why she would allow her Mother to starve to death. This was terribly upsetting to the woman who deeply loved her Mother.
Apparently, after speaking with me, she regained the ‘courage’ to tell the doctor to mind his own business–a feeding tube would not be inserted!
I vaguely remembered that encounter, but it was tremendously gratifying to have her there in my office, thanking me for my support. It is something that I feel strongly about and acted in a similar manner when my own mother stopped eating. She did not die with a feeding tube.
Once again, I would like to call for a national discussion/debate on the end-of-life issues. They do not go away by pretending they don’t exist. As the population ages and technology becomes more proficient at keeping all of us ‘alive’ and as financial resources for health care continue to diminish, the debate is no longer about private decisions–it must be exposed, discussed and dealt with.
We must address our own metaphysical beliefs before the time comes to act upon them. They must form the platform for our morals and ethics as well. They should be examined before tragedy and personal difficulties arise so that we can all make the best decisions for ourselves and our loved-ones.