Last week, I was talking to a 70-ish man with COPD and a variety of cardiac disease (ischemic, valvular). The subject was advance directives and code preferences.
"Let me ask you something important," I said. "This is something everybody should think about before they get really sick. It is possible to get to a point that you can't tell your family or your doctors what kind of treatments you want to receive. I don't think you're going to get that sick right now, because you're already feeling better, but I still want to ask this: if you were to get so sick that you couldn't breathe on your own, or your heart stopped beating, would you want the doctors and nurses to insert a breathing tube or press on your chest, or anything else to keep your body going?"
He had a few questions about the kinds of things which can be done when a patient goes into cardiopulmonary arrest, but finally he thought about these issues for a moment and said, "Well, hell, you can't live forever."
"That's true," I said neutrally.
"To tell you the truth, I don't know how much longer I can go on anyway," he said. "I'm getting pretty sick of it all."
We talked for a while longer, and by the end I believed he understood the state of his health and I did not think he was suffering from depression--in other words, he had the capacity to make his own decisions. He didn't want to undergo any resuscitative efforts, and so I wrote "DNR" on his medical record.
When older patients start talking about the end of life in a certain straightforward, unflinching manner, I take what they say very seriously. I've had more than my share of patients who looked great but told me they wouldn't be around for the Fourth of July or whatever milestone was on their mind--and before I knew it, they were being admitted for their final illness, or I'd see their name in the obituary page. So I've learned to respect these moments of foreknowledge as a kind of reckoning people go through before they end of their lives. There's no science behind this observation, just a feeling.
The man was discharged but I readmitted him a few days later, once again in florid CHF. He looked awful, grey-faced and barely able to speak to me. The next day, he died.
I'm telling this story because I'm in the middle of improving my home. Redecorating and decluttering serves as an uplifting distraction from all the wound care and doctor's appointments I've been attending with my partner, but there is also a serious thread underlying these frenetic efforts. Ever since we moved into this house three years ago, I've been aware that the floor plan had a serious flaw in its feng shui--specifically, the guest bathroom is in the wrong place. I'm not going to go into all the details, because feng shui is an esoteric tradition which is not supposed to be transmitted casually, but all you need to understand is that my guest bathroom is positioned so badly in the Chinese philosophy that we might as well apply a straight razor to our wrists and get the whole thing over with rather than let our pathetic little lives drag on miserably forever.
Superstitious? You bet I am. I was raised by an extremely well-educated mother who studied feng shui with a master and I spent most of my formative years vacuuming around oddly-angled furniture arranged to promote health and prosperity. My mother is the one who alerted me to the guest bathroom problem. After we moved in, we were forbidden to use it, but one of my cats snuck in and peed in the tub. A few days later, my partner fell off the porch and broke her tibial plateau. Pulverized would be a better description for the injury; we are still living with the fallout.
Over the last few years, not only have we not used the guest bathroom, we haven't even discussed it. I use it as a storage area for canning jars and I find myself averting my eyes when I enter. It's like a giant black hole at the center of my home. So the fact that there is no science behind the practice of feng shui doesn't matter a damn. The guest bathroom is a huge bummer. It's a huge waste of space and a source of constant unease. This is perhaps the truest manifestation of blocked c'hi.
When my partner was diagnosed with melanoma a few weeks ago, we were pitched into a dizzying round of appointments, fear, surgery, wound care, terror, pain management, and absolute panic. I did what any other red-blooded Chinese American person would do under similar circumstances: I decided to renovate the house. A major knee injury and four orthopedic surgeries weren't enough to get me to act upon the guest bathroom problem, but melanoma was.
So I've got a contractor working on an estimate to knock down walls and move the guest bathroom to another location. The current room is going to be converted into a big pantry, which I'm really excited about because I like to can summer vegetables and I need a lot of storage for Mason jars, both full and empty. Fortunately, the layout of the house permits these renovations to be done without too much disruption to the rest of the floor plan. I just hope it costs less than what I've got saved for retirement.
Since making the decision to renovate the bathroom, my partner's excision margins were found to be free of melanoma, and immunohistochemistry on the sentinel lymph node showed only a teeny 0.2mm micro-metastasis, which is relatively reassuring. Are the two things related? Maybe, or maybe not. There is no evidence-based practice for keeping hope and joy alive. When it comes to maintaining an affirmative grasp upon life, belief counts more than reason. Just a feeling.