“Do you know if he has designated anyone to be his health care power of attorney?” I asked the nurse. “Well, with the kind of life he led, I’m pretty sure he wouldn’t have done that,” she replied. Today I met a man for whom life has not been easy. For the greater part of his five decades on this earth, he’d had trouble with drugs. His mother told us that two of her sons struggled with this. She was tearful when describing that she’d thought he had stopped using drugs until the ER doctor told her that his drug screen had come back positive for methamphetamine. The look on her face when she described this was one of heartbreak, devastation, and utter frustration that even she couldn’t save him from his greatest demon. His latest episode of drug use had landed him in the ICU with a fasciotomy on his right upper arm, sepsis, renal failure, and a ventilator doing the work of breathing for him. He’d been lucky all the other times, but this one wasn’t turning out that way. His mother told us that, five years ago, she had to decide to withdraw life support from her husband who’d been very ill. She had already anticipated that this is what we were coming to suggest. “I just can’t be here when you do it. I can’t go through that again.” During our conversation, we discovered that our patient loved “pickin’ his guitar,” and had recently acquired an expensive electric guitar, which quickly became one of his prized possessions. During the early course of his illness, he had said to his mother, ”Don’t let them cut my arm off. I won’t be able to pick my guitar if you let them cut my arm off.” It turns out the nurse was wrong. This patient had designated his mother as HPOA. His mother told us that when the COVID pandemic started, he suggested doing this, and they designated each other as HPOA. The poignancy of this struck me only hours after our conversation was over. Here is a gentleman that has been all but written off by society because he’s a drug user. A waste of space and time. A burden to society. An addict. But here’s the other half of the story. He was also a loving son who cared enough for his mother to ensure that her ducks were in a row if she were to become ill with COVID. I bet he never anticipated that it’d be him in that ICU bed with a ventilator breathing for him. I cried when de-briefing this conversation with my attending. Not because I was frustrated or felt like I had failed at the conversation. In fact, this was one of my best goals of care conversations yet. I cried because I wanted so badly for this gentleman to be seen, if only in the last days of his life, as something more than his addiction. As a man who loved his mother despite his mistakes. And someone who probably did a damn good job pickin’ that guitar. I went out of my way to ensure his mother that, even if no one else saw him this way, that WE did. “Thank you for sharing his story with us. I’m so glad we have the opportunity to learn a little bit about who he is as a person.” And I meant every word. I found it odd that this struck such an emotional chord with me. After all, several years of my life had been effectively ruined by someone with a drug addiction. I’d developed a hardened attitude about people who used drugs, primarily because of the ways that that drug use affected everyone around them. Today, my heart told me that perhaps I need to rethink that, at least a little. When I think about Ed, and someone writing him off when he’s laying in an ICU bed dying from the consequences of his drug use, I’d want to step in and say, “But I want you to know that he was a brilliant architect, and could make anyone laugh. He had a beautiful smile and a big heart. He made mistakes. But he is more than those mistakes.” I hope that, even for a few minutes, I could give that same reassurance to a grieving mother. Source
