From: Daran Rehmeyer
Sent: Mar 28, 2007 8:51 AM
To: "'David H. Beyda, M.D.'"
Dr. Beyda: havn't heard anything from your side. Hope all is well: stones and all. I've found I'm losing weight without all the extra meals. Joking aside, what report did you get from your doctor?I also need some help dealing with Pepe here. While you may have to deal with the heroic vs compassionate care issue in the clinical setting, I think we are having to deal with it on a personal level here. At what point do you say enough is enough? Is that just burn out? When do we stop trying to get the next treatment when all the previous ones have been aborted or ignored due to uncaring/unloving caregivers? Her father in this case. When is it better just to let them go? Is that to minimize their or our pain?Really troubled.Daran Rehmeyer
Sent: Wednesday, March 28, 2007 7:08 PM
Subject: Re: help
Dear Daran and Teresa,
I'm sorry that you didn't get my email that I sent you last week with an update. I retruned on Tuesday night and Wednesday morning was having several proceedures done by my urologist to figure out what is going on. Here is the take: no stones presently but I have a horeshoe kidney, meaning that the 2 kidneys are connedted to each other and that increases the risks of stones. He has started me on a medication that will hopefully help in decreasing the stone formation. Also, I have to have a CT scan of my abdomen and pelvis 1 week before I travel anywhere to make sure that there are no small stones forming. That doesn't preclude the stones from forming during flight, etc. but will help a little bit. We have decided to let me travel again, at least for now.
As for the issue of Pepe. There are 2 rules in medicine, and as an ethicist and critical care physician, I find them to be very true: rule number one is some people die, and rule number two is that you can't change rule number one. If you try, you wind up with a vegetative patient, or a patient who suffers until they die. When you look at yours versus Pepe's suffering, it needs to be about her. The greatest gift we can give others is to relieve their suffering through care and compassion, even if it means letting them die. To prolong their death becasue we are not ready to let them go, goes against the grain of human kindness. I have had many occasions where I could keep a patient alive (we do our job very well in our intensive care unit), but allowed them to die comfortably, pain free and above all with dignity. I look at it like this: there is a difference between being alive and having a life. Pepe can be kept alive by insuring that she recieve her medications, etc. But what is her life like? Is it full of suffering, pain, abandonment, helplessness, and isolation? Or is she surrounded by those who love her? The answer is not simple, but honest: she needs to be taken in by those who love her the most, cared for and prayed for, keeping her comfortable and safe as she declares her end stage illness. Prolonging what is inevitable for our own benefit, is contrary to compassion. I am not minimizing your griefor feelings. But remembering whose she is and who she belongs to, is what is important. She is His. As a phyician I used to be a "god in a white coat" believing that it was I who controlled life and death. I was very far from the truth then. I have learned through Him that He decides when, where and how. Being with her unconditionally as she dies, without remorse or concern for ourselves, is true compassion. This is a difficult decision to make, but one that is unfortunatley already made for you: she will pass on, sooner than later. Make her life the sweetest it can be for now, and allow that which will happen, happen. I hope this helps. You are wonderful people, and your love for others evident. Love the dying as you love the living.
In all things, give thanks,