The power of love is alive and well. Huey Lewis & the News said it well in his Back to the Future hit single The Power of Love. Love can make one man weep and another man sing. The power of love can cloud the minds of rational men and women. The power of love can drive irrational medical decisions. The power of love can even drive men and women to experience great pain, suffering and self sacrifice to prevent the only companion they've ever had from experiencing the agony of lonely heartache.
As physicians, we often forget about the powerful forces that drive a patient to act. We are trained to look at data with an objective mind. We are trained to make decisions based on probabilities. We are trained to discuss outcomes based on objective data and clinical experience. If we find ourselves emotionally attached with our patients, our ability to remain neutral, for them, in the face of their adversity, could cause us to act irrationally as well. The power of love works both ways.
As physicians, we often forget about the powerful forces that drive a patient to act. We are trained to look at data with an objective mind. We are trained to make decisions based on probabilities. We are trained to discuss outcomes based on objective data and clinical experience. If we find ourselves emotionally attached with our patients, our ability to remain neutral, for them, in the face of their adversity, could cause us to act irrationally as well. The power of love works both ways.
While this may be viewed by many as uncaring, it is in fact necessary to remain emotionally neutral for the practice of sound evidence driven medicine. We need physicians that can cry for their patients, not with them. Patients are often viewed as a disease that can or cannot be cured. Patients are often viewed as a compilation of symptoms that can or cannot be managed. Patients rarely present to the hospital with a DRG. They don't come to the ER saying "I have an empyema". They say, "I'm coughing and short of breath". They want their symptoms to go away.
For many patients, money is a powerful motivator in their pursuit of health care decisions. "How much is my copay? How much is my deductible? Does my insurance cover it? My insurance is covering everything. I want you to to all my outpatient testing I had scheduled for next week while I'm in the hospital. While you're at it, can I also get my pap smear done as well?" For many patients, money is the motivating factor on how they make decisions on their health care.
However, the power of love is alive and well. Families make irrational decisioins all the time when faced the the finality of death. Advanced directives are reversed everyday when children and spouses have to face the acute nature of a dying loved one. In my seven years of hospitalist medicine, I have rarely seen the power of love play out right in front of my eyes as it did for my elderly couple. The power of love is real. The power of love definitely drives patient decisions, whether those decisions are based on sound medical principles or even a firm grasp of reality. Perhaps the power of love is a driving force of denial, driving a hope that everything will be OK.
I had the pleasure of taking care of Gertrude, a 94 year old farmer's wife, stricken with end stage age. Gertrude is the wonderful farmer's wife of Fred, her 97 year old knight in shining armor. The two of them have 12 children, four of which have already passed on, 26 grand children and 12 great grandchildren. The power of love in their relationship is incredible.
You see, not only does Gertrude have the advanced stages of life, she has end stage kidney disease (ESRD). Gertrude needs dialysis to survive. If you don't know anything about your kidneys, know this. Iff your kidneys don't work well enough to filter toxins and fluids, you end up swollen and dying of a quick and painless deadly heart arrhythmia or peacefully in your coma like state. Instead of accepting the limits of mortality with grace, the power of love has driven Gertrude to test the limits of suffering most humans couldn't bear to witness. Gertrude wants dialysis. She's willing to go to Hell and back, suffering through the weakness, the immobility, the nausea and dizziness, the infections, the sepsis and the pneumonias. She's willing to go through it all for the power of love. Gertrude doesn't care how much suffering she will endure by starting dialysis at the end stages of her life. She doesn't care how much it costs for her or her country. She doesn't care about any of that.
The only thing on her mind is the power of her love for Fred.
At one point, palliative care had been discussed. In fact, palliative care had been initiated. Until Fred's suffering became to much for Gertrude to watch. The power of love had taken over. Gertrude changed her mind. Palliative programs allow patients to die with dignity. Unfortunately, in this fantasy world of American health care we all participate in, saying no is not an option. Should 94 year olds with end stage renal disease even be offered dialysis. Should patients with end stage life be offered all the technological amenities of modern medicine?
When the Medicare National Bank was started almost half a century ago, none of the politicians could have predicted the economic implications we find ourselves in today. Medicare is broke and it's not getting any better. None in Washington expected this social health program to pay for dialysis to temporarily delay the death of our 94 year olds. None of it was planned for. None of it is being paid for. Not then and certainly not now. The question of appropriate medical therapy is not even on the radar of today's health care discussion. Not yet at least. It will be. Someday. It has to.
The power of love does not care about probabilities. The power of love does not care about patient expectations and mortality figures. The power of love does not care about how much kidney dialysis is going to cost others. The power of love only cares about Gertrude and Fred. That's how they have chosen to make their informed consent. That's the resource they have chosen to guide them through their mortality.
It's romantic. Almost 75 years of life with one partner. That's a tribute to their love. But love doesn't make rational decisions. Love doesn't pay the bills. There is no statistical p value for the outcomes of love. There is only the power of love.
I'm glad that this situation is rare, at least in my practice. Most of the ninety plus patients I take care of have already faced the death of their life long partner. Most have already accepted their own mortality with grace. Most do not make these irrational decisions based on love. Most do not pursue and demand therapies which will cause them great pain and suffering for the love of those around them. Most are ready die with grace.
But when the power of love is alive and well, all bets are off.
I had the pleasure of taking care of Gertrude, a 94 year old farmer's wife, stricken with end stage age. Gertrude is the wonderful farmer's wife of Fred, her 97 year old knight in shining armor. The two of them have 12 children, four of which have already passed on, 26 grand children and 12 great grandchildren. The power of love in their relationship is incredible.
You see, not only does Gertrude have the advanced stages of life, she has end stage kidney disease (ESRD). Gertrude needs dialysis to survive. If you don't know anything about your kidneys, know this. Iff your kidneys don't work well enough to filter toxins and fluids, you end up swollen and dying of a quick and painless deadly heart arrhythmia or peacefully in your coma like state. Instead of accepting the limits of mortality with grace, the power of love has driven Gertrude to test the limits of suffering most humans couldn't bear to witness. Gertrude wants dialysis. She's willing to go to Hell and back, suffering through the weakness, the immobility, the nausea and dizziness, the infections, the sepsis and the pneumonias. She's willing to go through it all for the power of love. Gertrude doesn't care how much suffering she will endure by starting dialysis at the end stages of her life. She doesn't care how much it costs for her or her country. She doesn't care about any of that.
The only thing on her mind is the power of her love for Fred.
"I can't stand to watch Fred suffer. I can't stand to watch him watch me die, knowing how much pain that causes him. I'm willing to go to Hell and back to keep Fred from suffering and watching me die."The power of Fred's love for his wife is just as strong.
"I want you to do dialysis on Gertrude. Even if it means I have just one extra day of life with my Gertrude, I want you to do it."I have to admit, this is a very unusual circumstance. By the time most of my patients have entered their 90s, they have already lost their spouse. They have already accepted their own mortality. Most of the time, they and their family, are willing to accept the probability of dying with age. Most of the time the discussion of kidney replacement therapy wouldn't even be considered.
At one point, palliative care had been discussed. In fact, palliative care had been initiated. Until Fred's suffering became to much for Gertrude to watch. The power of love had taken over. Gertrude changed her mind. Palliative programs allow patients to die with dignity. Unfortunately, in this fantasy world of American health care we all participate in, saying no is not an option. Should 94 year olds with end stage renal disease even be offered dialysis. Should patients with end stage life be offered all the technological amenities of modern medicine?
When the Medicare National Bank was started almost half a century ago, none of the politicians could have predicted the economic implications we find ourselves in today. Medicare is broke and it's not getting any better. None in Washington expected this social health program to pay for dialysis to temporarily delay the death of our 94 year olds. None of it was planned for. None of it is being paid for. Not then and certainly not now. The question of appropriate medical therapy is not even on the radar of today's health care discussion. Not yet at least. It will be. Someday. It has to.
The power of love does not care about probabilities. The power of love does not care about patient expectations and mortality figures. The power of love does not care about how much kidney dialysis is going to cost others. The power of love only cares about Gertrude and Fred. That's how they have chosen to make their informed consent. That's the resource they have chosen to guide them through their mortality.
It's romantic. Almost 75 years of life with one partner. That's a tribute to their love. But love doesn't make rational decisions. Love doesn't pay the bills. There is no statistical p value for the outcomes of love. There is only the power of love.
I'm glad that this situation is rare, at least in my practice. Most of the ninety plus patients I take care of have already faced the death of their life long partner. Most have already accepted their own mortality with grace. Most do not make these irrational decisions based on love. Most do not pursue and demand therapies which will cause them great pain and suffering for the love of those around them. Most are ready die with grace.
But when the power of love is alive and well, all bets are off.
