Article Series

How We Misunderstand Heroism and Heroic Action

Article submitted by Bart Windrum, author and speaker.

So You Say You Want to Die in Peace - Part 1

Last month I introduced the topic of dying in peace and listed a range of aspects we each ought to address to help increase our likelihood of achieving the peaceful death that most of us say we want, and that most of us fail to achieve. I promised you an unvarnished look at factors contributing to a non-peaceful demise. Here we begin with a singularly important one. What makes this singular is that it may be the sole factor that we have complete control over, for it pertains to our perception.

The national media is beginning to fill with citizen stories about patient-families with an aged parent at highly advanced ages and with numerous infirmities that undergo increasingly invasive treatments, the sum total of which represents a non-peaceful demise, despite having vowed “no more hospitals” and “no heroic treatment,” sentiments sometimes backed up with written advance directives.

This occurred in my patient-family; in 2005 my 84-year-old father self-admitted to a hospital for pacemaker eligibility testing. My folks had retired to Florida from Denver. Mom died about fourteen years later; it took Dad over a year’s grieving before he sold the townhome and moved to an assisted living facility offering a continuum of care. A touch flummoxed by the enormity of life changes, he realized that his few remaining cousins, and my cousins, did not comprise the family that I, my sister, and my wife did. Given two prior heart attacks and a heart functioning at only one-third strength, could he return to a mile high altitude?

He underwent the test and crashed medically, his system reacting badly to the testing protocol. After the crash he contracted urinary tract MRSA—a hospital-acquired infection—from a too-large catheter. He succumbed to that infection several weeks later. Dad had vowed “no more hospitals.” What happened (or, more accurately, what didn’t happen)? The answer is a complex range of things. The importance of how we view heroic activity occurred to me only years later as I wrote Notes from the Waiting Room: Managing a Loved One’s (End of Life) Hospitalization.

Then naive, none of us questioned whether any viable alternatives to an implanted pacemaker existed (such as an external pacemaker or an oxygen delivery system). We didn’t seek or explore any data regarding double-blind clinical trials around pacemakers and testing for them. We didn’t dream to pose the question about if found eligible would Dad want a non-refundable, always-on life-support system implanted in his chest at his age and condition.

And so we found ourselves in what unfolded as Dad’s terminal hospitalization, complete with life and death, pull-the-plug decisions that we never envisioned having to make given Dad’s advance directives—which were then, apparently, moot.

In truth, Dad’s period of medical heroism begin at age 65 with his first of two double cardiac bypass operations. I was there, I watched him get paddled (electro-shocked). Subsequent operations were heroic also: the two hip bypasses, the periodic swallowing of nitroglycerin to kick start his heart. No matter that bypass operations are everyday occurrences; if you or I undergo one I think I can guarantee that we’d consider it a heroic choice and experience.

After years of inquiry, study, and reflection, and based on this hospitalization plus my Mom’s three-week terminal ICU stay only fifteen months prior, I have come to see that we will always act heroically if we don’t recognize that we already have. We want to fight for life (and, if religious, to sanctify life). This appears to be our personal and social default — and it happens to be medicine’s default, so there’s no systemic resistance to it. In fact, the system tends to throw roadblocks in the path of those wanting the opposite (restrained, less, or no treatment until literally at death’s door).

Had we been able to frame his medical course over the last twenty years of his life, perhaps we might have felt stimulated to investigate and consider options beyond the chemical stress testing and/or implantation. Perhaps we would have found and chosen some other medical path, or none at all, or even self-directed Dad’s peacefully dying at a time of his choosing, given that his heart could not continue without a range of daily pills to support its pumping.

So, what medical heroism have you undergone in your life thus far? How many episodes? How many or few years (or months) apart? If you really want to die in peace, one key aspect—the only one under your sole control—is whether or not you have engaged in enough medical heroism to satisfy your moral or spiritual quotient around fighting for life.

Posted July 2012 on