In the midst of a global pandemic, it is time we normalize discussions about medical interventions, quality of life, and end-of-life care.
In the worst-case scenario if you are sick, you may end up where I work: The intensive care unit (ICU). You may be there because you cannot breathe on your own and need mechanical ventilation via an endotracheal tube, or because you are in shock and your body cannot sustain adequate blood flow to vital organs. No matter why you are in the ICU, the practice of medicine can often sustain your life, keep you alive, and give you the chance to get better, when in the past you might not have survived.
We have machines that can function as almost any vital organ in your body. We can pump you up with fluids, blood, and electrolytes, while giving you medications that increase your blood pressure, regulate your heart rhythm, provide pain relief, and sedate your nervous system.
In the best-case scenario, you get better, as many ICU patients do, and go to a regular hospital floor, or to a long-term care or rehabilitation facility, and hopefully someday go home. However, medicine still has its limitations, and surviving these interventions in an ICU can also result in many different complications.
Being on a ventilator for extended periods of time can cause your lungs, throat, and vocal cords to weaken or erode, and you are more prone to infections. Even if you are able to wean off the ventilator, you may be left with difficulties swallowing, eating, and decreased lung capacity. If you are unable to wean off the ventilator, you would require a tracheostomy, a surgically created opening in your neck which allows air to enter your lungs; however, even with a tracheostomy you may still require a ventilator.
Laying in a hospital bed for extended periods of time means you are more prone to have skin breakdown and pressure injuries, your muscles can atrophy as your body weakens, and you will be more prone to blood clots, which may travel to your lungs causing you to be more ill or possibly die.
These are just a few of the scenarios we face with our patients in the ICU. There are thousands of other complications that may arise. Each scenario and each complication can land you in a state of being or quality of life that you may not want, but without direction being provided by you or your family, a state to which you could be permanently confined.
With all these interventions, machines, and medications keeping you alive, at what point does it become “Enough is enough?”