The New York Times recently had a provocative essay about a man with progressive heart failure who made the choice to have a Ventricular Assist Device (VAD) insertion, even though it would be a “destination” therapy to which he would be attached for the rest of his life. The author, a critical care doctor, was curious about what life was like, living with the dependencies intrinsic to this heroic device. This particular patient markedly improved his quality of life with the VAD, and didn’t regret his decision a year later. He accepted the duties that came with care for the machine, the limitations in movement, and the fact that he didn’t have to worry about whether he would get a transplant (for which he had been turned down). He found new joy in being able to focus on enjoying his life for whatever time he had left. He knew at some point the machine – and he – would stop. But he embraced the freedom he had regained for his time remaining.
Often Palliative Care specialists are called in to help patient’s reconcile that their life is ending. We get asked to help people face their mortality. And to stop grasping at straws or heroic measures that may well increase their suffering. But we always need to keep in mind that different people give different weight to the choices they face. All of us adapt in ways we never might have predicted to a life that from afar may look too compromised to be “worth it.” But who knows what we will choose when up against those options. And in Palliative Care, we come to realize that our patients can make surprising choices too. And those choices may turn out poorly, or they may give them a couple more years of meaningful living.