I wrote this in honor of my dad, Dr. Howard Siegel, who passed away on June 18, 2012.
The past few weeks have culminated in a sorrowful irony for me, as my father advanced to the final, terminal stages of heart failure. Professionally I am immersed in a universe of promising new medical devices, while personally I witnessed the one-by-one elimination of technological solutions for my father’s grave condition. Percutaneous valve: not an option, he’s too far gone, too weak. Left ventricular assist device: contractility not his problem, it’s his valve. Implantable defibrillator: already in place and vigilantly awaiting the call to duty, time to turn it off lest it torture him in his final days. No more need for sophisticated tests or monitoring; nothing really to do with all that data. The declaration of surrender was strangely relieving to all, especially to my dad. Put down the arms, the battle is over, the retreat begun.
Replacing the beeps and whirrs of sophisticated technology were the hushed voices of nurses administering medication to lessen his discomfort, most of them cheap and old as dirt. Hydromorphone, methadone,lorazepam… have we really not invented anything better in all these decades? Hospice caregivers are a personality archetype I’ve rarely encountered in my work context of medical technology. Unmoved by gadgetry, a world away from cath labs and endoscopy suites, they trade in compassion, patience and treatment minimalism.
As a society, we place a high value on aggressive, invasive therapies that save, extend and improve life, and my father, with his bad heart genetics and love of ice cream, certainly benefitted for many years from the best our industry has to offer ’ bypass, angioplasty, stents, a pacemaker, the works. As an ophthalmologist, Dad himself employed medical technology in the care of hundreds of patients, practicing medicine for over 52 years until his legs literally gave out from under him.
Once he shifted to hospice mode, my father required only simple technology to ease his last mile; an adjustable hospital bed, some oxygen, suction. Even if someone were to invent an effective mechanical solution for improving end of life management, I wonder if such devices would ever gain acceptance. Perhaps the ancient palliative approaches we use today are as much ritual as rational. The obtrusive sights and sounds of medical technology do not seem to befit this part of life’s journey.