Holding on vs releasing

There are a few very sick patients in ICU as of now.

One man, in his 50’s who came into causality and arrested there, possibly due to intra-cerebral bleed. The admitting doctor did an excellent job in resuscitating and putting him on the ventilator. But the patient due to the underlying disease situation, was already brain dead. He is now on ventilator for the past 4 days. The family wants him kept alive, because the daughter’s marriage is coming up in the next few days. If the father dies or any death happens in the family, no marriage can take place for more than one year. And the extended family wants to avoid this complexity. And we have been requested to make it sure that he remains “alive” till the marriage is over.

There is another man, in his 40’s who is in and out of supportive ventilation after a pesticide ingestion. Though he wanted to take his life, today he wants to get out of ventilator soon. But as and when his wife comes in, his attitude changes – he gets angry. This is the same person about whom I wrote earlier in the blog on suicides. It does appear that there is something going on between the husband and the wife and he is not too keen to see her. But the desire to live is there. She also wants him back, because she says – I have 2 children, and no family support. She cannot live as a widow. (though there seems to be someone else in her life). Widowhood in this part of the country is challenging, both for her and her family’s survival and status. So the husband has to be kept alive somehow!

There is another lady in her late 70s who came with Septicaemia. She was on a visit to her family from Mumbai and fell sick and was brought in yesterday. Now she is on ventilator and being supported by various treatment modalities. Her son is quite keen that nothing happens to her. He told me, she has been quite non communicative and silent for the last one year (? Depressed) but otherwise has been well. Her presence in their lives itself was enough. One could see the love of the son, in his eyes when he asked us, will she get well. A desire to see his mother alive and well.

And there is this 13-year-old who has been with us for more than a month now, in and out of ventilation after a pesticide ingestion and multiple complications of the same. His father constantly keeps talking to us. He wants him alive somehow. The reason – he has three girls and only one son. So the son has to be kept alive. Like without a male child, is not thinkable for a family who has many compulsions due to the cultural expectations. He is willing to sell the little land and house he has for the sake of the son.  I was not sure, if this was one of his daughters’, the attitude would have been the same? (maybe I am seeing beyond what I should see). But whatever it is, the love in his eyes for his son, one could see and experience when we talk to him.

In each of these families, you see the love and desire to hold on to the life of their loved one – just because they love them. And they are willing to do anything possible for that. But in some of these situations, the holding on to life is also made complex by other cultural issues. Loving is about holding on to those whom you love. Loving is about releasing when time comes to release. Health care practioners get caught between the dilemma of helping families to hold on versus releasing when it is time to release. But to understand and make others understand that releasing also is loving, giving up is part of loving, is not an easy task. And to understand the socio-cultural back grounds of the people whom we see and interact, as we help them to release – a much more tougher task.

Why wasn't I taught any of these in Medicine?