As many of you by now already know, my Christmas 2014 was spent in the high dependency unit of the James Cook University Hospital. What turned out to be a “massive” bladder infection (never one to do anything by halves, you know) became sepsis and ultimately resulted in cardiac arrest. Deck the halls with boughs of holly—for a short while it looked as though I had eaten my last turkey dinner.
As you may already have concluded, however, I was successfully resuscitated and have now been home for a few weeks. All in all, I got off extremely lightly—no major organ damage and, while I still have energy issues, I am steadily getting back to my normal routine.
What I want to address here, however, is something that happened to me while in the HDU, a very short while after my cardiac arrest. This kind of touches upon an earlier post, in which I discussed my thoughts on assisted dying.
Fully compos mentis, but very ill and extremely traumatised, a doctor with whom I was already familiar (I believe he’d been part of the crash team that had resuscitated me), approached me and, after drawing the curtains around us, methodically approached the subject of resuscitation and, should I face a similar scenario in the future, whether I would once more want to undergo this procedure—given the possibilities of complications such as brain damage et cetera.
As I’m sure you will understand, this wasn’t exactly the kind of conversation—in spite of everything that had occurred—I was expecting to have. My prime concern had been how the hell I was going to get through this and find my way in life again. And, yet, here I was faced with an admittedly kindly doctor talking about whether I wanted to do everything possible to hold onto life should the worst happen (again).
Before I discuss my response, I want to make something quite clear: looking back, it’s very easy for me to see, now, that there was a bias on the part of the doctor—or there certainly seemed to be (my parents, who were present, would confirm this, I’m sure). The way the option was presented strongly suggested that he believed the sensible (dare I say “correct”?) decision was to opt for the “do not resuscitate” order. All my previous knowledge about the pros and cons of the procedure, and the simple fact that, in spite of my Type II SMA and all I’d been through, I still wasn’t a prime candidate for a DNR order, went out of the window. It felt wrong to push against it. In short, yes, I felt pressured.
Normally someone whose default setting is to question positions of authority, I—and I still find this quite bizarre—agreed that I wanted the DNR order putting on my file. Should my actually very healthy ticker stop ticking again, the same efforts that had worked very successfully would not be employed!
A few weeks later, another doctor thankfully questioned this. Sitting down beside my bed, he brought the subject up once more, telling me that he’d seen it on my file and that he’d wondered if I still felt the same way. He pointed out that, yes, it was indeed true that we can be resuscitated only to face a quality of life that we might not want, but emphasised that my heart was healthy and I had no history that suggested I was a likely candidate for a DNR order. Relieved that he seemed to be underscoring my feeling that I was not a completely lost cause, I was quick to say that I believed I’d been asked this question at the wrong time, and that I’d felt pressured into the decision I’d made. “So you’d like me to remove it?” he had asked; I’d answered with a very emphatic “yes”.
This is why I believe we have to be very careful about the life and death choices we offer with developments such as the Assisted Dying Bill. Sometimes, simply presenting the option exerts pressure. I am, I’m sure many would argue, not someone who is easily swayed. I’m fairly intelligent, well-informed and not inclined to change my mind without being presented with a convincing argument. And, yet, at, I suppose, my most vulnerable I made a decision that I now believe (and, more to the point, previously believed) I should never have made, a decision that could have had a catastrophic outcome.
I was lucky; I had the opportunity to correct this. But if that second doctor hadn’t questioned it, it might well still have been on my file.
We are all, however we might think of ourselves, highly suggestible. The presentation of a question, its timing and the way in which it’s framed, can quite easily prompt uncharacteristic responses. This is something we all—healthcare professionals and patients alike—need to bear in mind.
©2015 Gary William Murning
