How Do I Fix My Head?

I've recently learned that my reading base extends well beyond what I anticipated and probably even wanted (if you feel guilty now.... good :)). In all seriousness though, I cannot reiterate enough that I write for me. Its one of only a few ways I have found to adequately and fully express my jumbled and, at times, incoherent thoughts (as an aside, the other ways once included punching walls, which thankfully God has pacified such aggression). I share what I write - and hence think - because I believe often it can have implications for others, allowing them to ponder a subject they might not have previously - or possibly from a difference perspective. This is not to say I hold in such high esteem what I think and say, but rather I mean to emphasize the value of dialogue sprung forth from differing perspectives - and I truly doubt that you and I hold the same opinions regardless of whether our core values coincide.

One subject that has been on my mind recently is the difference between "comfort care" and "withdrawal of care." First lets be clear, I do not intend to entertain the topic of euthanasia - see Dr. Kavorkian, - which could be construed as similar to the above, but for these purposes will be left for another time. So what has me thinking of death? Obviously it stems from my time in the hospital, but more directly from of a patient I recently cared for. I will be as blunt to say, I think there to be a very distinct difference between these two realms of care. Furthermore, I believe, this difference becomes clouded in the hospital. Is this due to sadism of doctors and nurses? Certainly not. The more likely reason is because such terms are used with great frequence yet not given adequate contextual definitions.

Thus, I will begin by defining exactly what I believe each of the above terms to mean, hoping to stave off any unintentional confusion. First, "comfort care." In my eyes, it is care that aims to provide peace and, as much as possible, pain-free medical management in the setting of a terminal diagnosis. A bulky definition to be sure, but a definition nonetheless. So how then do I define "withdrawal of care?" Most simply, an intentional action of taking away some pharmaceutical or nutritional substance, or device, which thereby the end result is death.

So the difference? Both require actions, on one side for the provision of care - to make one 'comfortable' an action must certainly be taken - and on the other to stop the giving of care. Both have the same end point, death. But the difference, I would contend, is the intention - and therefore mindset - of the action. Having had two patients in the recent past placed on 'comfort care,' I have felt, in both circumstances, the care being provided was less than ideal.

The natural continuation of these thoughts has led me to ponder (not for the first time) how often one medical advancement to prolong our lives leads us to discover another limiting factor. Examples abound, such as better acute heart attack treatment that helped lead to the burgeoning population of heart failure patients. We weren't meant to live forever, this I know. Yet sometimes I feel trapped in an occupation that demands my commitment to ensuring the exact opposite.