Our Death Denying Culture

by Helen Lobato

Our six coronary care patients await their treatments. They are attached to cardiac monitors that note and record their heart rhythm and rates. Such observations are possible both in their rooms and via the central monitor at our nurseís station. At any given moment there are moderate level alarms warning us of non-critical rhythms and then there are the rapid, urgent, must respond NOW types of alarms that herald the fatal arrhythmia that must be dealt with immediately or death will ensue.

Itís a stressful workplace and as well as the constant vigil that must be maintained via the monitors thereís the patient care ranging from dealing with sudden central chest pain which may signal an acute heart attack to the simple but necessary task of taking a debilitated patient to the shower and toilet. More frequently now we fulfill the job of the educator to the new recipient of an internal cardiac defibrillator who fearfully wonders how he will manage if the artificial gadget in his chest goes off when it shouldnít. We give him details of where he can get help now that he has the alien thing in his chest. The job of a nurse gets more complicated as the technology progresses and there is not reason to think that it will stop any time soon.

Once the assessment of oneís patients is done there is the mad panic to transfer one or two patients to the general ward as there are another two waiting in emergency. The voice on the end of the phone says thereís no trolley space left and we canít wait while you drink your cup of cold tea. I bang the phone down, turn around and there is the patient atop the emergency trolley gasping for breath and seizing the ubiquitous vomit bag. As he is lifted into the bed still warm from the last incumbent, we begin our treatment.

Maybe I am just too old but there are no happy faces at work anymore. The increasing numbers of patients stressed as well they may be, their relatives worn out by the complete medicalization of their very lives and the staff worn down by the never ending cost cutting by their overzealous managers. The rapid pace of work is being driven by greed and the erroneous belief that the old can just go on living. For the ageing do not want to die and the medical system is all too willing to comply with life extension. Why did the old man who was left wondering how to deal with his defibrillator now firmly and forever in his chest agree to have it inserted into his very frail 85 year old body? His fatal arrhythmia is now denied him; for the defibrillator will shock him out of any chance meeting with death.

But why should we expect the old man to deny himself the slightest chance of more years? Throughout all our materialist lives we have been taught to believe a long life is desirable and possible and that we must do all we can to obtain increasing decades of existence. The mantra of how to live a long life is still Ďtop of the pops.í

Tragically the acceptance of death is nowhere to be found! Ironically, if we were to embrace the presence of death we might just learn to really live. As with birth, death needs preparation, not avoidance. There is no learning to die in our consumerist culture, where reality and death have no place and the endless search continues for immortality or at least some impossible form of after life.

It is no wonder that the old man with the cardiac defibrillator now residing in his frail chest has taken the option of a few more years even if it means sitting in a nursing home awaiting his postponed demise. Where is the public debate about the use of such technologies that are increasingly being used on the frail and elderly?

Back on the cardiac ward the central monitor alarms and we jump to attention. Seconds later another person is shocked back into sinus rhythm and life. My colleagues and I sigh, relieved as we note his reversion. Resignedly we acknowledge that soon he too will be fitted with an internal defibrillator so that wherever he is, whatever other condition he may be suffering, he will be once again shocked into life and the cardiologists will be laughing all the way to the bank.

Cardiac nurses are trained to resuscitate and care for their patients but increasingly there is disquiet in the ranks regarding our role in this life extension for its own sake. As one after another old person acquiesces to the whims of the death denying culture and its masters of technology, as nurses and patient advocates we need to ask ourselves if this is a role we can play anymore.