I had the gracious opportunity to perform cardiopulmonary resuscitation on a 93 year old. 93 years old. Let me say that again. 93 years old. Full code. 93 years old. The concept blows my mind. Why? Why? Why? What are the odds of dying for a 93 year old?
I find these actuarial life expectancy tables highly interesting. It tells you, on average, at each age, what your expected life expectancy you have left is. I don't know all the mumbo jumbo statistics that go into these figures. I guess I just accept them at face value. Lets take a peek...
As of July 9th, 2007,
If you are 65 years old, you can expect to live 19.20 more years.If you are 75 years old, you can expect to live 12.04 more years.Turn 85 this year? You can expect to live 6.43 more years.How about 95. That's old. But you still got, on average, 3.09 years left in you.If you are 105 this year, better make out your will. You only have 1.63 years left in ya.If you are 119 years old this year, you better go on that Caribbean vacation you've always wanted. You only have 0.53 years left in ya.
Now, statistics lie. Or at least can be bent pretty easily. My patient that coded? She had renal failure (I guess who doesn't at this age, right?) So does anyone really believe she has 3.83 years left in her? For all comers at 93, there is a 20% chance of dying in one year. Hardly. I suppose that 3.83 years includes all comers. You see, some will die in 1 month, some will live to be 105. Her probable mortality at 30 days approaches 100%.
That is a reality. If you are 93 years old. And you have renal failure. And you code. You should allow yourself to go gently into that night. Trust me when I say that. Your life, your quality, your independent functioning life as you know it? It's over.
Instead, patient and family chose an ungrateful march toward mortality So where are we know?
Pulling out all the stops.
and on and on and on. Why? Why all this madness? One reason. Fear of mortality. The inability to accept mortality. Why not do all this? Well, I can think of hundreds of reasons why not. But lets just say that this $50,000 + escapade (in the spirit of unmanaged upset patients). To cheat mortality for another few weeks could have provided a well baby check for over 250 babies. It could have provided groceries for a month for 100 families It could have provided heating assistance for 250 families for one month. It could provide 4 years of college at a state institution for one highschool graduate You see, when we cheat mortality out of its peaceful end game, we create death and disability, morbidity and mortality for an exponentially larger population. The moral good loses.
100 families to feed
250 families to heat.
Is it ethical to sacrifice the many for the few? Should we place extreme hardship on the many to delay the already defined outcomes of the few? I say it's not. My ability to spend millions of dollars to deny the peaceful end of a wonderful life existence, through the fully funded policy of coding 93 year olds, only to create that ungraceful march at the expense of 1000's of suffering people without the resources to survive.
That is of course, unless you believe in fantasy land economics. That we can have it all. All the time. Where along the way, did we as a society decide that cheating the inevitable grip of death in a natural quick and painless way was morally superior to providing enough resources to help poor people eat, get heat, get educated and allowing the future of our population waddle in inadequate care. I can think of no other better way to die than to code. Immediate death. Do I place less value on the 93 year olds life than a child? No. Never. Everyones life is equally important. Do I think as a society, in a land of finite resources, that having society pay to code a 93 year old instead providing well baby checks for 250 children is appropriate? No. FREE=MORE, until all the money is gone. Then MORE=LESS
I don't know anyone who believes that all care can be provided all the time at government expense. You simply stop breathing and pass out. It is the most peace, comfortable and painless way to die. It is the choice that I would pick 100 out of 100 times. There is no suffering. Yet here we are. Creating suffering for the patient. Creating suffering for all the lost opportunity cost of helping others. It's LOSE=LOSE And before anyone chimes in that I'm playing God with these decisions, remember doing nothing is a God like natural end. Doing everything is not