June, 2010 - Letting Go
Joseph I. Sirven, M.D.
As we look towards the month of June, we are faced with a number of very happy occasions that typically mark the beginning of summer and celebrate the connections to one another. At the end of May, we have Memorial Day, the first of the summer holidays, which is subsequently followed by Fatherís Day in June and then culminating with the Fourth of July celebrations. As we consider summer, vacations and plans involving transportation to a favorite destination for a holiday, to visit friends and loved ones or some R&R are on peoplesí minds. For most individuals, this may involve an airplane flight to some far off destination. For others, it may simply involve getting into an automobile and seeing the best that America has to offer with regards to parks, cities and other inviting places. For others it simply means visiting family and friends. Regardless of the location, for many individuals with epilepsy, the privilege of driving takes center stage during summer.
As a father of a 16-year-old teenage boy, I am reminded on a daily basis of just how important driving is to an individual. My son has attended driving programs, done endless road simulations and all for the sake of being able to have a driverís license which will certify him to be safe behind the road. I, as any typical parent, am always distressed the moment that my son gets into the driverís seat. Not because I have major concerns about his safety, rather, driving signifies that our relationship has changed in a fundamental way. Driving represents independence and this privilege reminds me that he will soon not be dependent on me for the basic necessities in life.
The other day before I was to make afternoon rounds, my son successfully obtained his driverís license which he excitedly showed to my wife and I. That same day, my son drove off for the first time to a friendís home. This was an outing that my wife and I had begrudgingly shared since the beginning of his school days and had come to cherish as those days became fewer and fewer. As he pulled away, my wife cried and we hugged, and I simply said ďsometimes we just have to let go.Ē
As I went to work the next day, I was also faced with another 16-year-old, but in this case, it was quite a different circumstance. This was a teenager who had been seizing continuously for weeks after an anoxic event from a serious cardiac arrhythmia which ultimately led to a persistent vegetative state. In this situation, I found myself face-to-face with the parents of this child. They shared with me the same fears, the same hopes, and the same goals that I have for my own child, which is to keep them safe, to keep them close. However, in this case of ongoing seizures where all options had been exhausted, there was only one way of letting go.
These disparate situations connect on the most basic emotional level. As I think about the plight of the status epilepticus patient that I tended to the same week that my son drove, I find it hard to know when is the right moment to advise patientsí families that all therapies have been tried and that letting fate take its course may be the best approach. Such decisions are never taught in medical school. I do not pretend to be God, nor do I pretend to be someone who is all-knowing and can, with certainty, know the outcomes of any given case. However, I do know that in some instances based on experience and scientific evidence that allowing a loved one to die can be a reasonable and merciful option. End of life decisions are devastating for all concerned and are even more so when it involves oneís child. So for now, we do our best as parents and physicians to reassure ourselves that our children and patients are safe whether at home or on the road. Therefore, I look forward to the summer holidays or any day for that matter which celebrates our connections to one another and hope that we can find the best way to improve quality of life, impart meaningful hope, and provide the best of care for all of our patients.
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