TDB&TB Question #1 ~ Medical Technology

by Jean-Dominique Bauby

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DeppInTheHeartOfTexas
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TDB&TB Question #1 ~ Medical Technology

Unread postby DeppInTheHeartOfTexas » Mon May 05, 2008 7:49 am

Welcome, Noodlemantras! :welcome: Sharpen up those #2's :writer:
and those typing skills :parrot: and get read for another discussion. :ONBC:
We are so excited to see old friends :wave: and looking forward to making new ones :hug: as we begin our chat!

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We will post one question per day. Please try to keep your answers specific to the question of the day but also please feel free to post your response at any time to any question already posted. And the #1 Rule at ONBC...there are no wrong answers, just good ideas! Ready? :bounce:


Pg 4. ‘”No need to wonder very long where I am, or to recall that the life I once knew was snuffed out Friday, the eighth of December, last year. Up until then, I had never even heard of the brain stem. I’ve since learned that it is an essential component of our internal computer, the inseparable link between the brain and the spinal cord. I was brutally introduced to this vital piece of anatomy when a cerebrovascular accident took my brain stem out of action. In the past, it was known as a ‘massive stroke’, and you simply died. But improved resuscitation techniques have now prolonged and refined the agony. You survive, but you survive with what is so aptly known as ‘locked-in syndrome.”

Mr. Bauby’s sardonic wit aside, can improved medical technology have a negative effect?
Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming -
Wow! What a ride!

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Unread postby teacher » Mon May 05, 2008 9:03 am

I wouldn't put his sardonic wit aside at all, he simply sums it all in that paragraph. Yes, new medical knowledge does prolong our lives, but whether it improves them is truely a question. It really pushes us to redefine what life is in the first place. I personally wouldn't call Mr. Bauby's condition "life", but then, I probably wouldn't be able to dictate a book by blinking.
Yes, I have tricks in my pocket, I have things up my sleeve. But I am the opposite of a stage magician. He gives you illusion that has the appearance of truth. I give you truth in the pleasant disguise of illusion. - Tom Wingfield, Glass Menagerie

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Unread postby Parlez » Mon May 05, 2008 9:20 am

Wow! Way to start the discussion! Nothing like a little controversy to get the old brain cells working! :lol:

Advances in medical technology and the resulting impact on an individual's quality of life is a very big, on-going debate, at least in the US. Quality vs quantity. Is prolonging life at all costs, and with any potentially debilitating outcomes, what the medical technology field is all about? Or are there other considerations that ought to be brought into the equation? It's a big question, with no easy answers.

Case in point: if Jean-Do had not received medical attention and been given the kind of extraordinary emergency/medical/technical care that allowed him to live, we wouldn't have this book to discuss. One could make a case for the use of technology at all costs right there. One could argue that as a result of being given life (albeit life altered) Jean-Do went on to make the biggest contribution of his life in the last two years of it.

Would that have been his choice? No. Would he rather he'd died? Possibly. Did he make the best use of the life he's been left with? Yes.

Okay ~ time for :morning:
Last edited by Parlez on Mon May 05, 2008 9:21 am, edited 1 time in total.
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Unread postby Betty Sue » Mon May 05, 2008 9:20 am

Sadly, yes. Mr. Bauby couldn't have gotten any more out of the time on earth extended for him, but he is very unusual, and he and his family encountered many negatives, too. The agony and expense of prolonging life for someone in pain and misery or with no quality of life is not exactly a positive for the victim or friends and relatives. Personally, my inclination would be to keep my loved one alive as long as possible, but, objectively, I think this is probably unwise. In my will I've asked that no extraordinary measures be taken. There's always the hope a cure will be found if the person lives long enough, but ....
"I never wanted to be remembered for being a star."

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Unread postby Inthezone » Mon May 05, 2008 10:09 am

Hello fellow Noodlemantras! I am excited to be joining you.

Question #1: "Can Improved Medical Technology Have A Negative Effect?"

The medications and techniques utilized for resuscitation purposes have improved drastically in the past 15 years. The American Heart Association (AHA) and American Stroke Association (ASA) set the standard for the care of imminent cardiac and stroke patients. These measures save viable lives when followed carefully and "time" is critical. Of course the location and extent of the anomaly is key when you use the word viable. Our motto is "time is tissue."

In quantification of brain death, a Neurologist must perform two Electroencephalograms (EEGs) 24 hours apart, where there is no brain activity noted. (this differs from a comatose state, where there is brain activity). When asked "how can you be sure?" This is how we are sure.
Life-saving measures (once begun) can be terminated at this point. I've seen many family members burdened with sorrow who cannot bring themselves to sign that form or make that decision. Therefore the patient remains in "limbo."

In the absence of a Living Will, medical professionals are required to use all measures possible to keep patients alive. And they will. This leaves the burden of responsibility on your loved ones. The thing is -- decide what you want for yourself and make it known both verbally and in writing (in the form of a Living Will) to your family and your primary physician.

I can speak from professional experience as I've worked closely with patients and families for many years as both a trauma nurse and Certified Stroke Assessment Coordinator. I have seen the devastation caused when a patient who is for all intents and purposes "brain dead" and being kept "alive" by all means possible.

According to the ASA only 10% of strokes occur in the brainstem, 65% of which do not survive in the first 24 hours. Those who do, remain with "locked in syndrome." Jean Do survived the statistics. Was he "fortunate?"

My answer to the question is that hundreds of thousands of patients remain in that limbo with no hope for real survival or any kind of quality of life in the future. I see it as negative. I would not want to live like that. I don't consider it living.

I hope this is okay and not too long. It's my first contribution to ONBC ... I don't want to wear out my welcome!!
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Unread postby Parlez » Mon May 05, 2008 10:45 am

Nice insights, Inthezone! (and Welcome!)

I take it from your report that there are certain points where someone has to make the decisions on behalf of the comatose patient...a family member or someone who's assigned Medical Power of Attorney. In Jean-Do's case I assume that person was the mother of his children. (If so, that might explain why he rather tersely commented on the fact that she was, indeed, not his wife. Perhaps a little bitterness there...?) Anyway, someone must have made the choice to keep him hooked up to life-support, right?

Also, I wonder if he was told how 'lucky' he was; what a small percentage of viable survival he represented? If so, maybe that inspired him to rise to the occasion and make the most of it. It seems like all the medical personnel around him were very eager and keen to see what kind of recovery they could help him make.

If nothing else, I hope this discussion encourages every one of us to get a living will in place!
"Belay that! ...Do something else!" ~ Hector Barbossa

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Unread postby DeppInTheHeartOfTexas » Mon May 05, 2008 11:28 am

Nice start, Noodlemantras! :bounce: We thought we would kick start our collective brains this morning. :ohyes:

Inthezone, your post is not too long at all and your technical knowledge on this topic is most welcome. We're glad you are able to join us for the discussion. :welcome:

Having been through this personally with a family member it is a very difficult decision. I can see both sides - hoping to prolong a life in hopes of a medical breakthrough and also knowing when to let go. As many of you have said, in Jean-Do's case we got his remarkable book which is good for us but at what cost to him and his loved ones? When is an individual ready to let go? I know someone who is struggling with the fact that a relative has requested to have a pacemaker removed so they can be allowed to die. There are certainly no easy answers here. I agree about livng wills! It is so much easier on those that have to make the hard decisions.
Life is not a journey to the grave with the intention of arriving safely in a pretty and well preserved body, but rather to skid in broadside, thoroughly used up, totally worn out, and loudly proclaiming -

Wow! What a ride!

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Unread postby magpie » Mon May 05, 2008 11:50 am

I am so thankful, in my Mom's case that we were spared what Jean-Do's family endured. She had what was termed a 'moderate stroke,' with total paralysis on her right side. While her recovery was hard, her therapists were able to help her tremendously.

I do believe that Jean-Do wanted & needed desperately to connect, to communicate, with others. His was an unusual situation, an unusual strength, and he used it to make a great contribution.

In the case of a brain-dead patient, I do question the merits of keeping the person alive artificially. It seems like it would be such an awful burden for the family to bear, almost moreso than letting the person go. However, since I have not experienced it personally, I can't say for sure how I would feel if put in that position.

What a difficult situation for so many, with no easy answers.
I'm having a thought here. . . .
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Unread postby Liz » Mon May 05, 2008 12:13 pm

:morning: I’m awake now. I was in a fog, but you ladies have jumpstarted my day. Great beginning to our discussion! Each of you have made some great points. :thumbsup:

As Parlez said, there is no easy answer to this question. I go back and forth on this issue. Always have. I guess it is because I believe in miracles, and, thus, why I put off filling out that medical directive. I am very thankful that our medical technology has come as far as it has. But like everything else in life, it is not perfect.

Parlez wrote:One could make a case for the use of technology at all costs right there. One could argue that as a result of being given life (albeit life altered) Jean-Do went on to make the biggest contribution of his life in the last two years of it.

This is a very good point that you make, Parlez. If not for the improved resuscitation techniques, he would have died without having made that contribution.

Inthezone, we are excited to have you join us. :welcome: And thanks for sharing your knowledge on this subject. I welcome anyone with in-deppth knowledge on any subject that is discussed here at ONBC to please share. It adds so much to the discussion. I look forward to more medical insight from you as the discussion progresses. :hatsoff:



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Unread postby gemini » Mon May 05, 2008 1:00 pm

Well, leave it to you gals to start out with the heavy lifting question. You have already covered all the major pros and cons and thanks to inthezone we even learned a bit of the process. I am one of those sitting on the fence about this issue. I have aged parents who are very definite about living wills and not wanting to live like that.

My mother knows me well and has threatened that I not try to interfere with their living wills. I do agree with their decision but will always have doubts and may panic at the thought of loosing them. Like Dithot, our family has been through some of these situation before and I have seen my parents who are strong willed people loose it.

My logical side says that no one should have to live like that if they don't want to but then if they cant speak how do you know if at the last minute they have not changed their mind? This tells you that if the brain is dead I would have no problem with the decision. Remember Parlez's question earlier about what you would choose to loose, body or brain? No brain feels dead to me but being able to think brings hope.

edit: I just had an afterthought. I was thinking of Celeste remembering her father. She recalls his death and the fond memories she had of him in the hospital that the film brought back.. She never says his life ended with the stroke.
"If there are no dogs in Heaven, then when I die I want to go where they went." Will Rogers

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Unread postby Endora » Mon May 05, 2008 1:12 pm

A very challenging question to start with, ladies.

I wonder if we are overlooking something here. It springs from the question about living to a great age, that is "Who would want to live to be 100?" The answer of course, is anyone who has reached the age of ninety nine. If he had been given the choice of having his ventilator turned off, I don't think he would have taken it. So if we take this as true, doesn't make it the action of the medical staff in keeping him alive correct? On the face of it, it seems that this should always be the case, whatever the quality of the life that remains.

The answer above, however, relies on logic, a cold and hard art. My head agrees with it, but my heart does not. There is something terrible about the death of dignity that accompanies these last ditch medically managed clingings to life, something belittling.
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Unread postby gemini » Mon May 05, 2008 1:24 pm

Let me add a little true story just for food for thought. My Uncle has COPD and was hospitalized 2 years ago and had to breathe on a trake. He had told my aunt that he wanted nothing done to save him and for her to stick to it. She told the Drs. that but I had been reading up on the Internet and I told her to wait and see. As it turned out the Dr. removed the trake and he breathed on his own and went home. He has now changed his mind and says if he goes through it again he wants to live because he would not want to have missed the last 2 years.
"If there are no dogs in Heaven, then when I die I want to go where they went." Will Rogers



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Unread postby suec » Mon May 05, 2008 2:30 pm

A very positive example, gemini. It shows that where's there's life, there's hope, which is what I tend to lean towards. He states that if the brain does decide to work again then it is at the speed of a hair growing from the brain - can't remember the precise quote, but it does imply hope. As does the slight progress made in being able to move his mouth. But I do think that the question varies from person to person. Jean-Do obviously had the imagination to keep himself occupied mentally and have a goal to work towards. There is also the matter of family circumstances - whether or not you have a family to think of. It isn't a decision I would ever like to make for someone else, although I may be called upon to do just that one day, my father having made his wishes very clear in this. For myself, I don't know what I would want in that situation.
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Unread postby Liz » Mon May 05, 2008 2:50 pm

gemini wrote:Let me add a little true story just for food for thought. My Uncle has COPD and was hospitalized 2 years ago and had to breathe on a trake. He had told my aunt that he wanted nothing done to save him and for her to stick to it. She told the Drs. that but I had been reading up on the Internet and I told her to wait and see. As it turned out the Dr. removed the trake and he breathed on his own and went home. He has now changed his mind and says if he goes through it again he wants to live because he would not want to have missed the last 2 years.


Stories such as that re-affirm my belief in miracles. :angel:
You can't judge a book by its cover.

The only thing that matters is the ending. It's the most important part of the story.

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Unread postby Inthezone » Mon May 05, 2008 3:00 pm

gemini wrote:I do agree with their decision but will always have doubts and may panic at the thought of loosing them.



Good point Gemini. (And everyone with contributions to this thread - valid food for thought)
Emotional setbacks are all too commonplace in emergency situations. Family members often panic when the time comes, and how could one blame them -- even if they are prepared for the death (as in cases of patients with terminal cancer). Even in situations where hospice is already in place and the "death plan" is very firm. Once 911 is dialed, paramedics are required by law to intubate and initiate resuscitation measures. Regardless -- unless a notarized copy of said will is literally handed to them by the power of attorney. So you can see how patients wind up in the ER - on the beginnings of life support and the long, grueling, painful dying process. It is never a choice made by medical personnel. It is only a duty to be carried out. Hopefully with care, dignity and sensitivity for the patient and the family. As a medical professional this is my hope.

Our family endured such a situation two years ago. My grandaddy had pneumonia which lead to bad pulmonary edema and refused to be put onto a ventilator in fear of never coming off. As a family we sat down and went over his living will and although it was the hardest thing we ever did, we honored his wishes and kept him "comfortable" using medical measures. Our hearts told us one thing ... our heads another. Naturally.

Such a painful and personal subject to debate/discuss ... we're bound to agree and possibly disagree with all of our personal contributions and experiences. BUT, that's the mark of a good subject!

P.S. Thank you everyone for the warm welcome! I am glad to be here with you all. :hug:
"For certain you must be lost to find the place what can't be found. Elseways everyone would know where it was." ~ Hector Barbossa


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