What is a meaningful life? What is a meaningful life? A meaningful life to me is one where one can say I had a full life. I took on the journey with a leap of faith and accomplished my goals, failed umpteen times but I tried again. I lived in the moment, broadened my horizons wherever I went and I served until I could not. It is a life where I can feel content with myself, have a clean conscience and be proud of the legacy that I will leave behind.

Martin Seligman describes a meaningful life as one in which individuals use their signature strengths and virtues in the service of something much larger than what they are (Seligman, 2004). People tend to refer to meaning as singular but, Emmons stated that peoples’ lives usually draw meaning from multiple sources which include love, family, work, religion and personal projects they pursue (Bannink, 2017).

In my 3^rd year, I never had to deal with a patient who is terminally ill or the death of a patient. This year however, I got to experience a bit of both. One day, after rushing through the day with half an hour to go before the work day ended, another patient arrived and was assigned to me. There she laid, an older lady with a very small physique, restrained to her hospital bed.The first notes I saw in the patient’s medical folder was “unresponsive to verbal instructions and to painful stimuli”. I immediately knew what my duty was going to be for  rest of the patient’s hospital stay. I had to see her every day even though I only had to do passive movements and re-positioning.

After a week, I consulted the patient’s physician. He brought to my attention that further treatment will be withdrawn and that she would be discharged from the hospital to her family – as the patient is not making any progress. To hear a doctor say, “we can’t keep her any longer, we need beds”, shocked me to my core. The patient’s family was not even involved when this decision was made. As far as I can remember health professionals have a responsibility to involve patients and their family in decisions concerning their care and treatment. It has been accepted as an ethically appropriate practice and is a part of health care legislation in many countries. Studies have found that the decision to discharge a patient were between nurses and doctors and that the patient was rarely involved. In most cases it is due to having a system with a fast turnover in order to prepare for new incomings (Ekdahl, Linderholm, Hellstrom, Anderson, & Friedrichsen, 2012).

According to the patient’s daughter, her mother had a full life before the onset of the cerebrovascular accident. She was always on the go, helping and serving others in her community as well as her family. This information influenced my thinking and caused me to look at the situation from a subjective point of view. I did not agree with discharging the patient to die at home. Can’t they try something else? They can send her to a Hospice facility. Why does it seem that they do not really care about her? Her family?

The one thing that came to mind was: When is the appropriate time to withdraw treatment? I would say you try until you have found something that might work. According to Braun et al (2007), interventions used in the cases of terminally ill patients fail to change the cause of the disease and can become inappropriate overtreatment, which eventually results in disease related and treatment induced harm to the patient. Before making critical decisions about cessation of treatment, doctors should focus on knowledge about the course of the disease and its responsiveness to treatment. The only treatment that the patient received was nursing care and physiotherapy. Therefore, the physician wanted to withdraw treatment so the family of the patient can continue with home care.

After discussing the patient with the physician, the only thing that came to mind was, “is it that easy to just stop and give up on someone”, without logically thinking and reasoning it through. Afterwards, I put a lot of thought into it and it dawned on me. Physicians and doctors don’t just rush through it when it comes to making these harsh decisions. They look at the progress of the patient and do further testing. They thoroughly think it through before discharging a patient home as hospital re-admissions are common and associated with considerable suffering of the patient, family and costs to the health care system. Studies have found that the vast majority of terminally ill patients prefer to receive care and die at home (Alonso-Babarro, et al., 2011). The patient will be given the opportunity to die at home – a space in which she is comfortable and with loved ones surrounding her. However, studies have shown that patients with terminal illnesses have a fear of being a burden for their families and some caregivers or family members suffer emotionally when having to take over the role of the health carers (Nolan, 2007).

References

Alonso-Babarro, A., Bruera, E., VarelaCerdeira, M., Boya-Cristia, M. J., Madero, R., Torres-Vigil, I., . . . Gonzalez-Baron, M. (2011). Can this patient be discharged home? Factors associated with at -home death among patients with cancer . Journal of clinical Oncology, 1159-1167.

Bannink, F. (2017). 201 Positive Psychology Applications: Promoting well-being in individuals. W.W Norton & company .

Braun, U., Beyth, R., Ford, M., & McCullough, L. (2007). Defining limits in care of terminally ill patients. The BMJ, 239-241.

Ekdahl, A. W., Linderholm, M., Hellstrom, Anderson, L., & Friedrichsen, M. (2012). Are decisions about discharge of elderly hospital patients mainly about freeingblocked beds? Journal of Clinical Pathology, 1-8.

Nolan, M. T. (2007). Patients’ Experiences of being a Burden on Family in terminal illness . Journal of Hospice and Palliative nursing , 264-269.

Seligman, M. (2004). Authentic Happiness. Atria Books.