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Are We Destroying the Sanctity of Death?

— A 21st-century version of the circle of life

MedpageToday
A retro video game screen in the style of Super Mario Brothers

In the cardiac intensive care unit (CICU), I experienced a bizarre feeling. One of my relatively young patients was dying from a cardiac arrest. He was in his 40s, and the only thing keeping him alive at this point were the machines, and us controlling the machines.

We were cooling his organs to make up for time lost during the 45 minutes of CPR and minimal blood flow to his brain during that time. It was like putting the remainder of dinner in the fridge so it doesn't go bad by lunchtime tomorrow.

However, with each day his lungs remained at our mercy via the ventilator. If we wanted him to take larger breaths, he would. If we wanted him to breathe faster, he would. When we turned up his dose of pressors his blood pressure would go up and when we turned it down it would go down. His wife just waited by the bed every day watching him closely for the slightest hint of improvement.

Unfortunately, we were the puppeteers artificially creating any glimmer of hope, and we had to ultimately explain that his brain injury was too severe, he would not be coming back. Yet, he was not entirely brain dead. He was on the border: relying on complete support, yet still with some minimal brain function exhibited by primitive reflexes.

And so, he was qualified to be a donation after cardiac death (DCD) organ donor. His family tearfully agreed.

Meanwhile, in the same CICU, a few doors down from our DCD donor lay our other 40-something-year-old guy. He would get short of breath with any minimal amount of movement because his heart just could not keep up anymore. He was just casually in bed hooked to an IV with a life-saving medication continuously running through him. This medication worked to pump his failing heart while he waited patiently and anxiously for a new one ... from someone like his neighbor, our patient #1.

Seeing this juxtaposition of life and death filled me with an eerie feeling. Like this is how it is these days -- this is the 21st-century version of the circle of life. I don't think this is what the original Hindus envisioned when they created the concept of reincarnation. Those like patient #2 had a second chance at living because patient #1 ran out of chances too soon. It's like in the video games when you happen to pick up a box with an extra life.

I tend to run out of lives too soon when I'm playing any video game so I appreciate the serendipity. I know that his organs were being used for good. But it felt like the organ donation team was a team of scavengers. They were eyeing out his organs with CT scans and ultrasound scans he himself would never benefit from. He was getting nutrition from tube feeds through his nose. Nutrition he no longer needed for himself.

I mean, don't get me wrong, I myself would like to be an organ donor in the case of an unfortunate event. It was just surprisingly kind of hard to see from the outside. Maybe because I perseverated on why? Why did patient #1 not make it, and why did the life of patient #2 depend on people like #1?

I won't deny there is beauty in that advancements in medicine allow us to find solutions for patient #2. Not everyone dies a death where their organs can be recycled either, and the fact that we can utilize such deaths is pretty amazing. But why couldn't they both live forever? Or at least for another 20 years? I just couldn't help but feel like the sanctity of death was disturbed.

"Rambling Resident" is an internal medicine resident at a large suburban hospital in the southern U.S.