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Guest column Jim Cahillane: Doctors are writing their wills

  • James F. Cahillane of Williamsburg. KEVIN GUTTING

Published: 4/5/2020 6:32:59 PM

One of our early retirement trips to the United Kingdom took us to the Plague Village of Eyam. History teaches us many truths and Eyam is an object lesson for today.

A bale of cloth had arrived from London carrying infected fleas in what became the Great Plague in 1665. Led by two ministers, the villagers of Eyam decided to heroically shut themselves off from the world. Knowing that many would die, men and women became the Bible’s good Samaritan example of neighbor. Their common sacrifice saved thousands of lives 365 years ago.

Today, Dr. Anthony Fauci’s is again calling on society to separate ourselves from each other to save people we will never meet. Frontline COVID-19 nurses, doctors, and first responders are today’s heroes.

I’m currently reading “Being Mortal,” a book by Boston physician, Dr. Atul Gawande. Little did I know that coronavirus would appear and force me to address issues raised in his book.

Most of the people I interacted with, until quarantine, were seniors. Few of us have illusions about what life holds for us in the not too distant future. Dr. Gawande’s book literally dissects America’s health system, its strengths and weaknesses. He quotes cases describing end-of-life decisions by patients and their families. Medicare statistics reveal that 25% of medical expenses occur in the last year and months of a person’s life.

His argument, as I interpret it, is that oftentimes life or death decisions are made by stressed family members that never got around to asking their loved one’s opinion before a crisis set in.

Intubation, in which a breathing device is inserted down a patient’s throat to aid breathing, is in the news. Ventilators, in short supply during this pandemic, may have to be rationed using criteria like age, life expectancy and value to society. That’s the Final Exam question of all time.

In one example, the patient’s children grasped at the doctor’s offer to do procedure after procedure that would, at best, add days, weeks or months to the patient’s time on earth. Doctors, says Gawande, are caught between their wish to help patients live, and saying that a cure is unlikely.

Unsaid by either party is the price paid in pain and discomfort felt by the patient. He or she is trapped, fed and breathing with tube after tube in every body orifice. Life is life, however, answering the quality question stumps ethicists and families. Ten years ago, I was that patient.

A blocked colon required that I undergo emergency surgery at Cooley Dickinson Hospital. Days later, a second surgery led to intubation, an induced coma, and my family pacing the halls outside my intensive care unit “resort level” suite. My Mount Everest-like task was to down numerous infections one by one.

It’s disconcerting, even now, to hear that my odds were 50/50. A coma is no help in making decisions, never mind the tougher life and death kind. The Sister’s of St. Joseph at St. Michael’s School advised us to pray for a “good death.” I likely never understood that lesson either.

At any rate, I’ve come to believe in the contention of Dr. Gawande’s effort: No one lives forever! To read of many young physicians hurriedly making out their wills in the middle of this worldwide pandemic sparks a question, what do they know that I don’t?

Obviously, a lot!

You have to admire those who make a career of healing to the best of their ability. I remember an agitated “M*A*S*H” surgeon Hawkeye Pierce (Alan Alda) screaming aloud at the specter of death during an operation. Questioned afterward he said, “I didn’t want him to win.”

When today’s virus-exposed doctors, nurses and EMT’s compose their wills, I wonder if their priorities will jell with my near-death dreams?

When I awoke after a weeklong induced coma, I had memories of things that never quite happened yet refused to leave. Three months later, I wrote down my dreams in a small book to avoid carrying them around. I titled it: “The Pilot’s Satchel.” It became an examination of conscience and fears.

Twenty-one dreams later, I had offloaded a lifetime of books read, travels taken, money here, money gone, going home, children, Big Band Leaders and their music, Irish Travelers, ICU nurses, hospitals, London theater, drugs, FDR, Churchill, the RAF, family, friends, body bags, waiting rooms, airplanes, World Wars I & II, railroad travel, Bertie Wooster and, at the last, having to decide which of two queues were Heaven-bound.

In this time of pandemic, I think of a friend who recently confessed her habit of reading the last line of a book before starting in to read it. She said it guiltily, like it wasn’t cricket to jumpstart the ending.

Dr. Gawande’s book’s subtitle is, “Medicine and What Matters in the End.” He closes “Being Mortal” at the bedside of his dying father. Atul’s book ends in four words, “No more breaths came.”

My “Pilot’s Satchel” chapbook ends in a prayer: “God send me my angel to show the way.”

P.S. Check out mydirectives.com for a free emergency, critical and advance care plan.

Jim Cahillane is self-quarantining in Williamsburg.


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