Let it Go 1

Let it Go.

Old beautiful woman

I just watched Frozen with my daughter.  The movie is fantastic.  The main character sings a sad song called “Let It Go” where she laments her childhood of isolation.  Currently, my daughter now rides her scooter around the house at 100 mph ramming it into our counters while belting out the song, cackling insanely.  This has nothing to do with the post, other than you should go watch that movie, listen to the song, and possibly periodically cackle for no good reason (see the end of the post for the song).

Several years ago I took care of an elderly woman in the ER.  She came in with a chief complaint of chest pain.  She came in via ambulance and by the time she got to the trauma bay she said she was feeling a little bit better.  She didn’t know she was about to die, usually people who are about to die look much worse.

She looked good, all things considered.  She was dressed simply, yet elegantly, as if she had gotten dressed and primped a little before coming in.  In retrospect, she probably had.  My mother would never have considered going to the ER before she had taken a shower and gotten ready, it was just how she was, this elderly beauty was the same.

I took my normal history and physical, asking all the regular questions, making the occasional jokes as I have a tendency to do.  She smiled and we started a chest pain work up.  I rarely ask the DNR questions.  It is something that I should probably do much more regularly, but in a busy ER I often forget in the heat of the moment.  I have absolutely no idea what prompted me to ask them in this specific case.  Not.  A.  Clue.  But, for whatever reason, call it gestalt, hunch, or just plain luck, I asked the questions.

Me:  Ma’am, if your heart stopped beating, or you needed to be resuscitated would you want us to perform CPR or put a breathing tube in?

Her:  Son (when you are over 80, you can call me Son, Sonny, Kid, or Poopface for all I care), I have had a great life.  If it’s my time to go, just let me go.  I don’t want anyone banging on my chest or putting tubes in me to help me breathe.  I don’t want any medications keeping me alive.  If it’s my time, just let me go.

Me:  Yes ma’am

So off I went to continue seeing patients in other parts of the ER.  I have no idea about the other patients I saw that night.  All I remember is that sometime later a nurse called me urgently back into her room.

You can guess the rest.

Her blood pressure was 56/24.  Her heart rate had increased to a million.  Whenever a person is crashing hard in the ER the room seems, almost magically, to fill with people ready to help.  So I had four nurses, three techs, and an assortment of minions ready to medically kick ass and take names.  It was then that I did the one thing that never comes easily to an ER doctor.

I did nothing.  We let her go.

We did not start pressors.  We did not intubate her.  We did not start CPR.

Her blood pressure continued to decrease to nothing.  I turned off the cacophony of alarms.  We watched her die.

Could we have intervened?  Of course.  In this case we likely could have gotten her back.  But it wasn’t what she wanted.  She had been very articulate on that point.

We let her go.

In the ER, we see death more than most.  Usually patients come in non-verbal.  When a patient comes in unconscious and actively receiving CPR, distancing myself emotionally is easy.  Once I have a conversation with a person, it changes everything.

But this it true in all of life.  Once connected, we create a bond that sometimes can be hard to let go.  What can be dangerous, however, is if we cling tightly to the things that actually are doing us harm.

Letting go can be the hardest thing in the world.

Personally, I have a tendency to cling to painful experiences.

Letting go of the mistakes, embarrassments, and failures I find difficult.

I am not an introvert.  I can be boisterous, flamboyant, eccentric, and just plain loud.  But sometimes the loudest voice of all for me is the one inside.  You know that voice.  That dirty little jerk that hides in your mind putting you down.  That voice that whispers “you should be doing more,” “you’ll never really make it,” “you should feel bad about X.”

I can be my own worst enemy, silently berating myself and tearing myself down from the inside.  I know many people struggle with this as well.  Do any of you ever do this?  The world is more connected now it has ever been, yet I think people often feel more alone now than ever.  You can have 2,000 “friends” on facebook and feel so alone inside it hurts.

Sometimes the best intervention is just to let it go. Stop beating yourself up over past failures.  Let it go.  Stop ruminating about an ex, or a betrayal, or even that time where you did everything right and still did not get what you were hoping for.  We’re not really all that alone, no matter how much that sinister voice might whisper.

Let it go.

Let me know if you ever need a hug.

Sorry about this post not being funny, I promise more poop jokes in the next one.

(here’s the song from Frozen.  It is sad, since it punctuates her loneliness)

Frozen: Let It Go

If you liked this post, please click “My Page” below and then click “LIKE” on my facebook page.  Does anyone else feel the hypocracy of this after the post above?  No?  Good.  It really helps boost my ever so fragile ego.

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One thought on “Let it Go

  • Debi Wong, FNP Hospitalist

    I think the fact that you let her go does NOT mean you failed. If you had intervened despite her wishes and she died, then that is a big failure. The last everyone I meet in my clinical setting is a bunch of heroic measures that cause a lot of pain and suffering,

    Many hugs to you…long distance!