9 Dec 2012


<p>Ella Rubeli/The Global Mail</p>
Dr Peter Saul

IT’S FRIDAY MORNING at Newcastle’s John Hunter Hospital and intensive-care doctor Peter Saul is on the phone to a surgeon, advising him how to deal with 87-year-old Charlie*, who is trying to kill himself. The overdose Charlie took yesterday didn’t work and now, after stabbing himself several times with a kitchen knife, he is in a critical condition. The surgeon is calling to ask Saul whether he should overrule Charlie’s wishes to die and try to sew him up.
“He doesn’t want to take any medication,” the surgeon says.
“He doesn’t want to have a blood transfusion… he doesn’t want to go into ICU [intensive care unit], he never wants to be ventilated…”

One after another, the surgeon’s heroics cards are trumped, and the thought of breaking the life-saving mantra drilled into him since his university days has him huffing into the phone.  IS THERE IN THE LAW-- apparently.
“This old guy is terrified that he’s going to end up in a nursing home — which he will — so he’s trying to kill himself rather than have that outcome."
Charlie also doesn’t want to end up in ICU, that section of the hospital that increasingly lives up to its nickname, “the departure lounge”.
Spending your last days in ICU, as one in 10 Australians do, means dying in an unfamiliar bed at the flick of a switch, while tethered to a feeding tube, a dialysis catheter and a breathing machine — “machines that go ping” so Saul calls them.
Most of us don’t want to end up in this situation.
Families want everything possible to be done to extend the life of their elders, even if it’s just for a month. If their loved one is drifting in and out of consciousness, it is the family’s decision, made in consultation with the doctor, that determines what happens to them.
“Dying has become a private thing and a shameful thing and it’s not the public domain at all any more,” Saul says. “You no longer just die in your sleep, you die in a managed way.”

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