To Pull Plug Or Continue Life Support?
To plug pull or to continue with live support? As a certified Advance Care Planning (ACP) facilitator and trainer, this is part of the conversation we hold. Previously, I was dabbling with the now-defunct Good Death Project, trying to promote the concept of dielogue to improve death literacy. Hence, ACP falls neatly under the umbrella of dielogue naturally, since it is something we can take action upon after discussion.
The main idea for ACP (General) is a directive for healthy people to consider their medical preference in advance in view of what living well means to them. It is also important to note that ACP is not Euthanasia lite. Its main use is to provide some sort of standing instruction, should we be struck with serious brain injuries that render us the inability to communicate. This state can be best described as someone clinging desperately onto their last thread of life via a life support machine. Though it may sound like a tragically rare occurrence, it really isn’t that uncommon. Cardiac arrest or a freak accident may render us in such unfortunate plight easily.
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I would describe such scenario as a toilet paper situation: you won’t really think too much into it. But when you need it and you don’t have it, it can be a tricky situation. In fact, I never had anyone within my first degree social network going through this. After all, working in older adults and end-of-life setting, such experiences have always been work-related.
Until now – someone I know personally is in the situation where ACP (General) specifically deals with. It was as if my training text came alive. Not virtual reality, but reality reality.
The quiet culprit was cardiac arrest. In fact, there are about 1,000 cardiac arrest cases in Singapore every year, equivalent to about 3 cases per day. It is extremely painful when you hear it first-hand from the doctors about your loved one suffering from serious irrevocable brain injuries. The idea of indefinite period of comatose with uncertain prospect of regaining consciousness is not an easy news to digest.
The flood of disbelief is real. Reckoning how family life was disrupted and how drastically the change happened overnight is highly disconcerting. Unlike terminal illness where you have time to plan and say farewell, sudden crisis like these deprive you of these human acts of love.
Making sense of our tragedy usually comes later, sometimes with no proper resolution. And regardless of spiritual belief or personal philosophy, I doubt anything will really prepare us for such an outcome.
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I visited the said person and a cloud of sadness washed over me. I could see his mother visibly trying to remain strong while relating the events leading to his stay at MICU. There was an occasional surge of heartbrokenness whenever she reminisced about how good of a boy he is. As I witnessed her dedicated care towards him, every comforting touch she laid on her boy was nothing but love.
The situation was grim, short of divine intervention. The wistful feeling of seeing a young man robbed of his potential future in an instant is just dolefully heavy. She recalled the moment when the doctors announced the impending possibility of her brain-dead son, of which two specialists would be called in to make that judgement. As we are fully aware of that process, the hospital organ transplant coordinator would be activated shortly after brain dead certification. Under the Human Organ Transplant Act, the deceased must be certified brain dead before retrieval of organs can proceed.
Then what come as a miracle is one mystical breath of air from him that rendered the certification as invalid. What this mean is that there was still life within him, despite the breathing being irregular and weak.
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Signs of life can ironically make decision making harder. Should we continue with intubation and subsequently a tracheostomy to carry on with indefinite life support? Or should we pull the plug and limit the physical suffering for him? Either way, the route is equally painful for the family no matter which way we go.
Although I can’t profess that I can fully understand how it feels like to be in that situation, but no parents should ever go through such an ordeal. The grief is probably indescribably deep and traumatising.
Pray hope that the family finds strength and courage in midst of this crisis.
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