One family felt ready to pull the ventilator. They knew that the husband, father, and grandfather laying in the hospital bed would not want to endure these medical trials. The intensivists felt that he may recover if we give him just a few more days on the vent.
A daughter who traveled from the mid-west wept openly and expressed her anguish at all of this: she wants to allow her father a death with dignity. If we do extend his vent trial, when we do as medical professionals allow him that graceful death surrounded by loved ones? Once all hope had faded and the family exhausted further? That daughter planned to fly home and return later in the week.
Yes, this man may survive. But will he live? He is surrounded now by his daughters and loved ones, why wait? They appear in a state where they can begin to grieve. Extending his life for questionable gains seems cruel and unnecessary.
I also see the medical side. We cannot in good conscience withdraw a potentially life-saving treatment: otherwise we creep too close to euthanasia. He may recover good function.
However, we ask for patience when it is not our hearts breaking.
Life on the palliative consult service is filled with gray. As I witness more cases and discuss the ethical quandaries of each, I am filled with a yearning for clearer goals. Absolutism and absolution.
I have found my sense of peace on the Go board.
I began playing with college friends. It proved quite straightforward to pull them into the seductively simple game. Then, I found random opponents to play via matchmaking. More recently, I hassled my father into a few games with me. Now, I have about ten boards going at once. Whenever I check my phone between consults in the hospital, I find a few stones waiting to be placed.
The rules are incredibly simple. One player places black stones, the other places white. The board looks much like a chess or checkers board, except pieces go at the intersections. When stones are placed, they stay put unless captured. The stone is captured when surrounded by the opponent’s stones. You win by points, determined from captured stones and controlled territory.
While the rules are simple, they allow for emergent properties within the game. Surrounded territories are invincible and unable to be captured if there are two “eyes”. There is no specific rule about two eyes, but they emerge from basic rules such as no suicide, which mandates you cannot place a stone that would only be immediately captured.
Additionally, the large board (19×19 for professional games, 9×9 for beginners) creates an infinitely large number of possibilities. From a statistical standpoint, no two Go games have ever been played the same, despite its thousand-year history of continuous play. There are so many branching possibilities that for many years scholars believed, unlike Chess, computers would never be able to beat the top human Go players. Humanity has since been toppled by AlphaGo, a Google-based AI, but the war for superiority still rages.
The game reminds me of StarCraft, another Korean specialty. I love the strategy, attempting to read the mind of your opponent. Why did they place that stone there? Will they see my motivation behind placing this stone here? Do they not see this vulnerability or is there something more subtle afoot?
I particularly enjoy playing with my father. He told me that the ancient Korean name for Go is SuDam, or conversation through hand. He plays in a style that is completely different from my friends, having played as a child but not for the past 40 years. My uncle is apparently quite skilled at this game, ranked highly and I look forward to learning from him. We do not speak the same language, but we do play the same game.
When I play Go, the world is simple.
Life off the board is less clear. I await interviews for residency. I schedule interviews around the expected due date of my child.
Another case, the other side of the coin. We go into a family meeting with the intention of changing the code status from full to DNR/DNI. We want, but won’t force, the family to withdraw the ventilator. We consult two intensivists who grant him a terminal diagnosis, absolving us of the guilt of euthanasia.
The family gathers for the meeting. Tears are shed as the decision is made together to withdraw the vent. He dies two hours later.
Long Form Sundays
- On a tale of two caretakers
- On demanding conversations (or the beginning of Hospice and Palliative Medicine)
- On the tumble of life (Or Child/Adolescent Psych: a post-mortem)