Butler Between Life and Death

A Gospel-Centered Guide to End-of-Life Medical Care
1. Auflage 2019
ISBN: 978-1-4335-6104-7
Verlag: Crossway
Format: EPUB
Kopierschutz: 0 - No protection

E-Book, Englisch, 224 Seiten

'To prepare yourself to make difficult medical decisions in a distinctly Christian way, you won't do better than to read Between Life and Death.' -Tim Challies Modern medical advances save countless lives. But for all their merits, sophisticated technologies have created a daunting new challenge, namely a blurring of the expanse between life and death. The dying process is often hidden behind a complex web of medical terminology, statistics, and ethical decisions, making it difficult for patients and loved ones to know how to approach the end of life in a dignity-affirming, Godhonoring, faith-filled way. This book offers a distinctly Christian guide to end-of-life care. It equips readers by explaining common medical jargon, exploring biblical principles that connect to common medical situations, and offering guidance for making critical decisions. In these pages, readers will find the medical knowledge and scriptural wisdom they need to navigate this painful and confusing process with clarity, peace, and discernment.

Kathryn Butler is a trauma surgeon turned writer and homeschooling mom, who writes regularly for the Gospel Coalition, desiringGod.org, and other platforms on faith, medicine, and the power of great stories. She's the author of many books, including the Dream Keeper Saga, a middle-grade fantasy series with Christian themes.

Autoren/Hrsg.

Butler, Kathryn

Leseproben

Introduction

Their nightmare of blood transfusions and emergency surgeries receded into memory with a whisper.

As the respiratory therapist removed the tube tethering him to the ventilator, he sputtered, coughed, and squeezed his eyes shut. Then, with an oxygen mask misting his face, his eyes locked with his wife’s. For the first time in two weeks, he spoke, his hoarse voice barely audible: “Hi, Hun.”

“We’ve missed you,” she answered. Tears welled in her eyes, and her limbs relaxed, like taut petals unfurling. In that moment, the burden of the car accident, and the havoc that had seized them for so many days, seemed to slip like silk from her shoulders.

The nurses and I beamed. Stories like this had drawn us to critical care. After long nights standing vigil over him, turning dials, adjusting medications, and stilling our frantic hearts, his injuries—his shattered liver, his lungs foaming with blood—no longer threatened him. The laboratory results and the ventilator settings no longer dictated his days. God had reunited husband and wife with a draught of air.

While the nurses still reveled in his recovery, I walked into an adjacent room to check on another patient. My joy ebbed as I stepped through the doorway and laid eyes upon the elderly gentleman who withered into his mattress. He relied upon the same battery of machines that had rescued our car accident survivor, yet his illness had assumed a starkly different trajectory. A massive stroke had paralyzed him and obliterated his capacity for language. Jaundice yellowed his skin to the color of turmeric. Bruises mottled his arms as blood leeched into his tissues. Although a formidable array of lines and tubes pumped and churned, his organ function dwindled. He was dying.

As I stood at the doorway, his wife sat beside him with her gaze distant and her hands limp in her lap. We had already spent hours poring over numbers and statistics. We had discussed prognosis, outlook, disease processes, and research. Yet during those long hours, I had failed to address the anguish twisting in her heart.

“Do I have any right to make decisions about his living or dying?” she would ask, as my team and I inquired about whether to continue life support. “Isn’t that God’s place, not mine? I don’t think [my husband] would want any of this, but I don’t know what’s right.” She would search our faces for the reassurance she lacked, and when we offered none, she would place a hand over his to stroke the contours, once so familiar, that disease had bloated beyond recognition.

As I stood in the doorway this time, she did not raise her eyes to greet me. In the dim light, I barely discerned the silvery lines staining her cheeks. She had been crying for a while. “He’s the one who usually helps me with hard things like this,” she said, with her gaze still fixed on the past. “I miss being able to talk to him. I feel like I’m the one dying.” Finally she looked at me, her expression weary and pleading. “I wish God would just tell me what to do.”

In the right circumstances, modern critical care saves lives. The moments when I have lifted my most raw and heartfelt praise to the Lord have occurred within the walls of the intensive care unit, when I have witnessed his grace and mercy made manifest in the recovery of a child battling a widespread infection, a man fighting for his life after a motorcycle crash, or a woman whose heart strains in the throes of a heart attack.

Yet medical technology harbors a dark side. When an illness cannot be cured, aggressive interventions prolong dying, incur suffering, and rob us of our ability to speak with loved ones and with God in our final days. Ventilators steal both voice and consciousness. Resuscitation looks a lot like assault. In the ICU we often awake in panic and find ourselves physically strapped to a foreign bed, deprived of the familiarity and comfort of home. We clamber for air, only to find we have no freedom and no voice.

When our critically ill loved ones cannot speak to us, we wrestle with impossible decisions of whether to press on or to withhold treatment, all while we yearn to hear a beloved voice again. Like the wife holding my dying patient’s hand, such dilemmas thrust us into grief, doubt, fear, anger, and even guilt as we struggle to reconcile a web of hospital instruments with a mother’s voice, a father’s laughter, or a child’s smile. While we wrestle, concerns about faith also haunt us. Death is a profoundly spiritual event that rips from us the people we most cherish and pitches us into doubt about suffering, mercy, and the God whom we serve. What is God’s will? we ask. Why is God allowing my loved one to suffer? What does the Bible allow in this scenario? Such questions tap into our deepest anguish, a pain that echoes from our origins as image bearers torn from God. Death is the wages of our fallenness, and the final enemy (Rom. 6:23; 1 Cor. 15:26). Even Christ wept in the face of death (John 11:35).

Yet when they deliver devastating news, too often physicians—and I include myself among the culpable—ignore these concerns and suggest chaplaincy services as a conciliatory afterthought. We focus solely on monitors and machines, and, in so doing, we transform death from a process directed heavenward to one steeped in nomenclature and obscurity. Percentages soothe little when we pine for hope. Medical terms offer no solace when the soul thirsts for God (Ps. 42:1–2). When it so heaps decisions of life and death upon us without a grounding in faith and Scripture, medicine casts us adrift, rudderless. We stumble forward under duress, without understanding how the lines, tubes, and numbers equate with the truth that “death has been swallowed up in victory” through Christ (1 Cor. 15:54).

The idea for this book arose in my heart during my ten years caring for patients in the intensive care unit (ICU), first during my surgical and critical care training and then as a trauma surgeon who worked extensively in the surgical ICU. Over the course of that decade, I had the privilege of partnering with people during their most vulnerable moments, and I loathed the disconnect between the technical details that I laid out and the pain tearing them apart. As I would lean forward in my white coat to inquire about resuscitation and feeding tubes, the weight of unvoiced questions bore down upon us—questions of God’s authority, of his goodness, of sanctity of life, and of suffering. These questions sprang from concerns fundamental to our Christian faith, but they hid beneath the trappings and decorum of a secular medical system.

To honor God in the bleak setting of the ICU, we must clarify the expanse between life and death that our medical advances have blurred. The shift of dying from the home to the hospital challenges us to acknowledge the capabilities and limitations of the technology upon which we lean, and to embrace it in a fashion that keeps the gospel in focus. Compassionate, gospel-centered guidance in end-of-life care requires a consideration of medical technology through the lens of heaven. We must unravel the jargon and the statistics and appraise them against the clarifying light of the Word.

When I speak of “life-prolonging,” “life-sustaining,” or “organ-supporting” technology, I refer to the array of medical interventions that augment or replace failing organ systems, e.g., ventilators for failing lungs, and dialysis for failing kidneys. Doctors usually implement such measures in emergency or ICU settings, when organ failure is life threatening. The introductory chapters of this book provide a framework for understanding such treatment in broad brushstrokes, coupled with a discussion of the biblical principles that undergird Christian medical ethics. Thereafter, chapters focus on specific categories of life-sustaining technology. These discussions revolve around individual patient encounters and include in layman’s terms candid explanations of the interventions, their limitations, and their curative potential.

I have changed identifying details, including gender and diagnosis, to protect the privacy of the patients and families who inspired this book. Additionally, in some places I have combined narratives into composite accounts to more effectively highlight key issues. Throughout, however, I have endeavored to preserve the rawness of the struggle that patients and families face as they navigate end-of-life dilemmas. In particular, the conversations are accurate, taken in many cases from my own notes over the years of encounters I dared not forget.

My hope is that through this book, Christian believers grappling with decisions about life-prolonging measures can confront their situation with peace and discernment. Although clergy and healthcare professionals will find Between Life and Death useful, I wrote it for patients and their loved ones as they face the unthinkable. If you are facing terminal illness or discussing end-of-life wishes with a physician, I recommend reading...