Let me live, let me die

Column-Dr-Saturnino-Javier-photo

Prime Angle

Saturnino P. Javier, MD, FPCP, FPCC, FACC

HE HELD my hand tightly as I stood beside his bed that morning. Eyes welling with tears, face betraying years of hardship, skin ashen from years of dialysis, arms and neck area bearing scars of repeated punctures and IV insertions, Leo (not his real name) looked at me intently – “Doc, we know this is not going anywhere. We are just prolonging the inevitable. Please, please, let me die. Let me go.” I froze.

All of 40 years, Leo had been under my care for various medical illnesses which eventually took a toll on his kidneys. Kidney transplantation was considered, but was not pursued for various reasons. Thus, he was faced with the prospect of long-term dialysis to keep him alive, to keep him going, and to keep him enjoying the company of a daughter and wife.

When I regained my bearing, I could only tell him that there was nothing I could do actively to let him go. I told him – “Someone Else calls the shots. Someone Else decides when it is your time – or anyone’s time.” But I assured him that when the time comes, I will respect his wishes and will allow him to go quietly, peacefully. He has expressly maintained a Do Not Resuscitate/Do Not Intubate (DNR/DNI) choice.

On the afternoon of the same day, in my outpatient clinic, Mrs. M. Perez (not her real name), a 64-year-old widow with lung cancer who was on regular chemotherapy sessions had a follow-up for her other cardiac problems. After the usual banter was over, an eerie silence crept in. After I took her blood pressure, she held my hand real tight. And a feeling of déjà vu engulfed me – as the scene vividly recaptured what transpired with Leo that same morning. Eyes welling with tears, face betraying months of pain and suffering, she looked at me intently – “Doc, please let me live for a few months more. I want to reach my 65th birthday next year.”

For the second time that day, I froze. She had three daughters and a son accompanying her, but no one in the room was saying a word. All I could say was, “I will try my best to extend your life, with the Almighty God’s help.”

Mrs. Perez clearly viewed me as the passport she needed for a few more months to live. Leo thought the same – but for the other reason. Hethought I had the capability and the prerogative to end his suffering. They both implied I should play God with them – and their lives.

In one day, I segued from a plea for death to a plea for life. Leo viewed death – as the instrument to assuage his pain and suffering. Mrs. Perez viewed more months to live – as the gift to allow her to endure more pain and suffering.

Dr. Jack Kevorkian thought otherwise. He believed he had the right to respond to any person’s exhortation to end life and suffering by dying. He was an American pathologist, arts enthusiast, and most especially, a euthanasia activist – known for promoting the terminally ill patient’s right to die through assisted suicide. Referred to in the media as Dr. Death, he claimed to have assisted at least 130 patients’ deaths. He stuck to the belief – that “Dying is not a crime.”

Kevorkian allegedly assisted the deaths of his patients by attaching them to a euthanasia device called a Thanatron (Death Machine, from the Greek word “thanatos”, meaning death) which he himself devised wherein the patient pushed a button to release the drug or chemical that would bring about death. Others were assisted by a gas mask fed by a canister of carbon monoxide called the Mercitron (Mercy Machine). In 1991, the State of Michigan revoked his medical license and in 1999, he was convicted of second-degree murder and served eight years of a 25-year prison sentence.

For all the Leo’s and the Mrs. Perezes, I can only exclaim how I dearly value the trust, how I am deeply humbled by the confidence and how I am truly honored (and committed) to be just an instrument of the Higher Authority. But simply put, I cannot do a Kevorkian or a reverse Kevorkian on anyone.

Vital Signs Issue 85 Vol. 4, March 1-31 2016