Real Life Includes Death

Recently, I wrote a post about dying and how we’ve lost touch with it in our modern lives. Death and burial has been taken over by the funeral industry. The process of dying has been taken over by the medical industry. This post touches on another aspect.

How to let go.

In our area, a young girl has been in the news the last week. She had a routine tonsillectomy and suffered sudden complications. She’s been declared brain-dead, but the family is, quite naturally, struggling with this. They’ve got a court order to force the hospital to keep her on life support. The judge has ordered a court-appointed doctor to examine the girl tomorrow. Presumably, the judge will use the doctor’s recommendation to decide whether or not the hospital should disconnect her or not.

I have a good imagination and lots of empathy, but I know I can only skim the surface of what this family must be feeling. Fifty years ago, there would have been no question that their daughter had died. It would still have been tragic, but no one would have questioned whether she was dead or alive.

Now we are forced to wonder. Medicine can keep the heart beating and the lungs breathing practically forever. Brain death, for some people, is a difficult concept to understand. We can’t see or hear it, like we can a heartbeat or breathing. We have only machines and a doctor’s word that death has occurred. When the death is so unexpected, we want to deny it. Even in the best of cases, a family may want to wait, may want corroboration, which I believe any doctor or hospital would also require. In fact, they do require a second or even third opinion. The hospital in this case already had three independent doctors examine the girl. All of them brought the same diagnosis of brain death.

So why can’t this family let go? There may be lots of reasons, but it’s not my goal to discuss this particular family in this post. I want to widen the issue to include all of us. How do you think of death? Do you have criteria that must be met? If (when) it’s your loved one lying there, will you accept it, or demand life support until a miracle happens? For how long?

I can only look at myself to answer that question. I can really only answer it for me. If I’m the person who is brain dead, what would I want?

First, I want to know what “brain death” means. I haven’t searched out a doctor to explain things, but there’s a reasonable article here. Below is a list of tests done to determine brain death.

The positive examination for brain death includes the following:

1. The patient has no response to command, verbal, visual or otherwise.
2. The patient is flaccid, with areflexic extremities. The patient has no movements — the arms and legs are raised and allowed to fall to see if there are adjacent movements, restraint or hesitation in the fall.
3. The pupils are unreactive (fixed). The patient’s eyes are opened and a very bright light is shined into the pupil. The light will activate the optic nerve and send a message to the brain. In the normal brain, the brain will send an impulse back to the eye to constrict the pupil. In the non-viable brain, no impulse will be generated. This is performed in both eyes.
4. The patient has no oculocephalic reflex. The patient’s eyes are opened and the head turned from side to side. The active brain will allow a roving motion of the eyes; the non-functional brain will not. The eyes remain fixed.
5. The patient has no corneal reflexes. A cotton swab is dragged across the cornea while the eye is held open. The intact brain will want the eye to blink. The dead brain will not. This is performed in both eyes.
6. The patient has no response — either purposeful or posturing — to supra-orbital stimulation. The patient’s eyebrow ridge is compressed with the thumb. The resulting stimulation pressure will cause motion of the extremities, either purposeful or primitive posturing, in the living-brain patient, but none in the brain-dead patient.
7. The patient has no oculovestibular reflex. The patient’s ear canal is inspected to ensure an intact tympanic membrane and that the ear is free of wax. While holding the eyes open, ice water is injected into the ear canal. The drastic change in ear temperature will cause a violent eye twitching by the intact brain but no reaction in the brain-dead patient. This is performed in both ears.
8. The patient has no gag reflex. The movement of the breathing tube (in and out) or the insertion of a smaller tube down the breathing tube will cause a gag reflex in a comatose patient, but will not elicit a reflex in the brain-dead patient.
9. The patient has no spontaneous respiration. The patient is temporarily removed from life support (the ventilator). With the cessation of breathing by the machine, the body will immediately start to build up metabolic waste of carton dioxide (CO2) in the blood. When the CO2 level reaches a level of 55 mm Hg, the active brain will cause the patient to breathe spontaneously. The dead brain gives no response.

This all seems straightforward, especially since most hospitals require more than one doctor to perform the tests and provide a diagnosis. So if I’m the one lying there and tests show I’m brain dead… please, take whatever you can use for someone else, then unhook me from those machines.

Put simply, the person is just not there anymore. No matter how long machines keep the body breathing and the heart beating, the person, the soul, is gone. It’s fascinating to consider the idea that everything that we are is a synergistic effect of electrical and chemical charges in our brain. The body can be nearly destroyed, but if the brain is able to function, we are still there. There are levels to this, of course, including deep coma or vegetative state. Those conditions bring their own set of moral questions and decisions.

Brain death = dead. This has always been true – brain death is not a “new” thing. All that’s new is our ability to actually see it. If the article I quoted above is accurate, then someone who is brain dead will cease breathing if taken off of life support. The heart will stop pumping. The body will show all the normal, reliable signs of death that we’ve used for thousands of years. I would hope that my friends and relatives would understand this, if I am the one in that condition. Don’t leave me in a hospital, hooked up to machines and fed nutrients through tubes.

Let me go. Mourn. Celebrate my life. Know that I was thrilled to share life with you. Then move on with your own lives and live them to your fullest ability.

That’s the best eternity I could have.