Movie Review: The Sea Inside

My timing in watching this movie may not have been ideal. I picked up the DVD at Blockbuster the day after I got my grandmother's will in the mail.

The Sea Inside is based on the true story of Ramon Sampedro, a quadriplegic who fought and lost a 30-year campaign to end his life with dignity.

Although the film did its best to address concerns disability activists may have with Ramon's arguments that living a life as a quadriplegic was living a life without dignity, this movie definitely brings up complicated questions about:

What is quality of life? And who decides if my life is valuable?

The point Ramon Sanpedro and euthanasia activists make is that a quality life and dignity are subjective. Only each of us can say whether our lives are worth living.

In the end, Ramon Sanpedro is not euthanized. However, he commits assisted suicide.

I sobbed at the end of this film - for the losses Ramon's loved ones experienced, but tears of content for Ramon Sanpedro because he finally achieved his 30-year dream of being freed from the constraints of his life.

I do not support quadriplegics requesting euthanasia. But I support individual people making their individual decisions about quality of life, including having the option to choose assisted suicide under appropriate circumstances.

And that reminds me - don't forget to vote if you haven't on the question of assisted suicide in my sidebar. I will be posting the month end's results and then putting up a new question in the beginning of July.

Grandmother's Will

My grandmother's will arrived in the mail today. I don't know how I was expecting myself to feel about it. But the tears welling up in my eyes surprised me. I kept trying to tell myself that receiving something from her was suppose to make me feel better. Like a salve for my broken heart. I guess I was surprised that it didn't help any. Instead, it was another reminder that she's gone.

A fresh wave of grief washed over me as if she'd died yesterday, not on March 8th, as the letter so plainly reminded me in its text.

When I got back into my apartment, I picked up my grandmother's cat and held her in a snug embrace. Despite the cat's mild squeals of protest, that physical contact with a warm living creature - especially one that my grandmother once held - helped a lot more than her money ever will.

And still the tears pour down. My chest heaves once again with the weight of my sorrow.

I wish I could be happy for her that she was freed from her failing body.

I feel selfish for holding onto my grief. For caring more for my own losses than for her possible gains - if you believe in that sort of thing. But perhaps that is part of the problem; I still don't know what I believe.

Movie Review: What the Bleep Do We Know!?

As usual, I am a litte slow with getting to the cinema. In fact, as most often happens, I waited for this film to come out on DVD. But I was so delighted to finally get to see it.

What the Bleep Do We Know definitely poses more questions than answers. Through interviews, scientists and medical doctors grapped with some of the existential crisis-like questions that my friends and I first debated over in adolescence. Why are we here? Is there a God? Who am I? Am I my thoughts and emotions?

I was most fascinated by the references to Dr. Masaru Emoto's work proving the effects of thoughts and feelings on water. Go to that link and see it for yourself. When "love and gratitude" were written on a bottle of freezing water and spoken aloud, beautiful crystals were formed. But when "You Make Me Sick" was written and spoken, incomplete, asymmetrical patterns in dull colors emerged. Since our bodies are composed primarily of water, this seems to be further evidence of the mind-body connection.

I'd be curious to hear from others you have seen this movie. If you haven't seen it, check it out and tell me what you think.

Palliative Care in an Out-Patient Radiation Setting????

Just some things that are on my mind these days that I thought I'd share...

I am doing my summer clinicals in an out-patient radiation/oncology clinic. My goal in being there is to become familiar with palliative radiation for intractable bone pain and for symptomatic but incurable brain tumors. I have been surprised, however, how little focus there has been on end-of-life care. Some of the patients are enrolled in hospice and some patients are explicitly receiving radiation for palliative purposes without hope of a cure, but there seems to be generally little discussion of or comfort with death and dying. Prognoses are whispered, "He's not doing well. I'm not sure how much longer he'll make it." But that seems to be the extent of it. I have sat in on discussions of prognoses between patients and their doctors. But despite the low-pressured time the patients get with a nurse, it has surprised me that this subject hasn't come up yet. I am wondering how a radiation/oncology department might incorporate palliative care (beyond physical symptom control and palliative radiation) into its practice.

Your Truth Scenario: Will You Pray with Me?

We all have differing levels of comfort with spirituality and religion. We all come from different backgrounds, some including a religious up-bringing, some without a religious up-bringing.

Patients come to the table with an equally diverse relationship with their spirituality and/or religion.

In this scenario, a patient asks, "Will you pray with me?"

Whether you are in a medical profession or not, I'd love to hear your responses. Please let me know a bit about your relationship with spirituality and/or religion and then tell me how you would respond to this request. If you are not in a medical profession, you can relate it specifically to your line of work or simply answer it theoretically.

Scenario 1: The patient has a different religious/spiritual background from yours.

Scenario 2: The patient has the same or a similar religious/spiritual background as you (if you have one).

Your Truth: In-patient Mourners

Here is another scenario. As a reminer, this is a fictionalized scenario meant to inspire discussion. I am providing a scenario and would like to hear how you would respond to it.

The patient is an 80-something male. He has end-stage liver disease. Two weeks ago, the doctors told his wife that he had only a few days left to live. The wife has been standing vigil at the patient's bedside, waiting for him to die. The doctor's prognosis was a little premature. The patient looks like he could live for another few weeks to a month.

The patient is alert and is able to respond to yes or no questions by nodding his head. He speaks very rarely, but when he does, he makes perfect sense. he still drinks lots of water and will sip on an occasional milkshake.

As you walk in the room, you hear the wife shouting at your patient, "Go! Just go! Why won't you die?"

In front of the patient, the wife turns to you and loudly says, "He is being so selfish! All of his children and grandchildren have cancelled their plans because they're waiting for him to die. But he just won't go! I would never do this to my family. Why won't he die?"

How do you respond? Hint: answer first, what do you think the wife might be feeling?

The Sweetest Patient

I had the sweetest palliative care patient yesterday. Well, I don't know that I can say that; almost all of my patients are incredibly sweet, particularly the palliative care ones. But this patient touched me very deeply.

We had to use a translator as she didn't speak English. Normally, one might expect a language barrier to create an emotional distance as well. But most definitely not with her.

Most of the day, the patient's daughter and I did fairly well communicating. And every time I went into the room, the patient always flashed me the warmest, most beautiful smile.

At the end of the day, I was preparing the patient for transfer to an in-patient hospice facility.

In case you don't understand the difference between palliative care and hospice, I will try to briefly explain.

Hospital-based palliative care units are generally for short-term care. This may be either in managing a pain crisis for a patient already enrolled in hospice but requiring an intravenous pain infusion. Or this may be for a patient who is transitioning from curative care to palliative care. We can provide both curative and palliative care simultaneously, which hospices don't do. Or patients may be hospitalized when they are imminently dying and then die in our comfort care suites. Some people prefer to die in a hospital or their families may prefer it.

In contrast, hospices do not provide any curative care. They are excellent with symptom management, although not all of them will perform more invasive symptom-management treatments such as continuous infusions or palliative radiation. There are also differences in insurance reimbursement, which I won't go into in detail, as that is not my area of expertise. I would welcome others, especially those who work in hospice to help clarify other differences that I may have missed, as this isn't exactly the focus of this post in terms of the story I am telling.

Anyway, this patient was not imminently dying, was not in pain, and had stopped all curative treatments. So we had no reason to keep her in the hospital any longer, so we discharged her into an in-patient hospice program.

With the help of a translator, I reviewed her paperwork with her and her daughter. Afterwards, I approached the patient to say my goodbyes.

She again flashed me the loveliest smile. But as she continued to smile at me, her eyes started to cast downward. Then her lip trembled and tears flooded her eyes.

She was sitting in a chair. There was nowhere nearby for me to sit, but I wanted to position myself on her level. I did my best by leaning in towards the chair she was sitting in. I put my arm around her, gently rubbing her back and expressing my sympathy with my eyes to the best of my ability.

The translator was still busy with the daughter across the room.

The patient then took my hand, held it in hers and pressed it against her face. I was deeply moved - by her sorrow, her sadness, her warmth and affection.

The translator, by then, had returned. "You touched her," she said with a melancholy smile.

Sometimes I have to remind myself: Death is inevitable. It's going to happen to us all. Medicine can't keep it at bay forever. All I can hope for is to make the journey a little easier, even if only for one day.

Some days, that doesn't feel like enough. I just want to fix it. Yesterday was one of those days.

But I will never forget this patient. What a beautiful woman. I hope the rest of her journey is lighter and brings her peace.

April Poll Results: Do You Believe In Ghosts?

So you may have noticed that I have a new poll up in my sidebar. I'm thinking of maybe doing a monthly poll. I'll call this new one my June poll and we'll see how it goes.

But in the interest of saving the data you've provided with your responses to the previous poll, here are the results from the poll I removed from my site:

Total Voters: 64
Question: Do You Believe in Ghosts?

21 (33%) Yes, in theory
19 (30%) I see/ hear/ feel/ smell ghosts
15 (23%) No
6 (9%) Undecided
3 (5%) Too afraid to believe

It seems the majority believe in ghosts.

I've heard from at least one reader that her response was not listed as an option. Since the nature of that survey was very limiting, I'd love to hear from others what your thoughts are on ghosts.