Faith Makes It Easier To Die

I'm sorry if I offend people who don't believe, but it is my belief, based on my observations as a respiratory therapist who gets to know many people near the ends of their lives, that Faith makes it easier to die. Faith makes the transition from life to death easier.

When I first started out as a respiratory therapist, I remember seeing people in the end stages of their diseases reading books. I see them watching the news. I'd see them worrying about paying bills or fixing a computer at home. I just couldn't fathom why they would be trying to educate themselves, or why they'd spend time worrying about trivial things when they knew they were going to die. How could they do that? Why would they do that?

There was one lady I remember in particular. She was told she had basically no heart left. She had an ejection fraction of 20% or something like that. She was essentially told she was going to die, and might not even make it out of the hospital. And she didn't.

But when I visited her she was more interested in me than she was herself. She was asking me about my life and my kids. She wanted to learn as much as she could about me. And I told her about me and my family. I showed her pictures, at her request, of course. And she smiled and was happy to see my kids and hear about them.

This is something I see a lot. And in nearly all of these situations, I see a Bible on the bedside table. Or, at least, I'd see some sort of emblem of Christianity. I'd see a cross, a note on the piece of paper from a grandchild saying, "God bless you, Grandma." Or sometimes they would just bring up God or the Bible in the process of whatever discussion ensued.

It was this lady, however, who gave me the idea that God needs people who are wise. When a carpenter dies, for instance, it's because God wanted a carpenter in Heaven. When a Grandma dies, it's because God needed another Grandma in Heaven. She said that we all have a gift to offer, and it's our duty to continue offering this gift all the way to the end -- which is not really the end, but the beginning.

I think it is this type of Faith that makes living easier when the end is near. I have no proof of this but based on my own observations, and the observations of my friends, you would have a tough time convincing me otherwise. What do you think?

God and success

You can disagree with any opinion, yet you cannot disagree with statistics. And every statistic regarding God and success shows that those who believe in God have more successful lives, and have more overall satisfying lives than those who do not believe.

Yes I believe in God. Yet it is also been my belief that even if I did not believe in God I would still raise my children in the world of God; I'd still go to church and have my kids learn about God and Jesus and Christianity. History shows, as the founding fathers new, that individuals function better when they believe in God.

Sure, if you believe in some other God or maybe even the Peanut Butter Ferry or Judas Priest that's fine too. What's important is that kids believe if they are good they will be rewarded in the end of life, and if they are naughty they will be disciplined at the end of their lives.

Likewise, people who are generally good, who live a frugal life and have their priorities in the right place are happier themselves, and they are seen in a more positive light by other people.

I believe this is why the Soviet Union failed, because they tried to get rid of God and religion and churches. The belief here was that in a socialist society, the state is supposed to be the true religion. To benefit all of society, the people are supposed to worship the state. The state knows what's best. The experts in the state know what's best.

It's also why the French Revolution failed, because the french revolution didn't favor the individual, as God would.  God believes all individuals are valuable to a society, including those who disagree with you.  That strong opposing opinions are good for a functioning society.

The French Revolution lead to the bloody slaughter of hundreds because they didn't value the individual.  Those who didn't believe in the revolutionary cause were killed.  It also resulted in the dictator Napoleon.  So as you can see, revolutions don't always result freedom. 

The American Revolution lead to freedom because the founding fathers believed in God, and they believed that the rights of men come from God, and can only be taken away by a government. 

Yet if there's religion, then people will worship the religion. Christianity especially preaches personal freedom, or individual freedom, or individual rights. The Bible preaches that to get to Heaven we must be good on this earth.

People who believe in God live happier lives.  And patients that believe in God are happier patients.  It is my observation that if you have a patient with a life threatening illness, and he or she is in good spirits, chances are that patient is a believer. 

I'm sure that's not always the case, yet as a rule of thumb the most pleasant patients are the ones who believe in God, because just knowing your life will not end when your body expires is somewhat soothing to the mind.

The stick of Moses

Most of the time when we face a conundrum the answer is in our hands.

Moses said to the Lord: "The Red Sea is before me, and the Egyptian Army is behind me. What am I going to do?"

God said, "What do you have in your hand?"

Moses said, "All I have is my staff." So he set his staff in the Red Sea, and it parted, making a path for him and his men. The Red Sea was parted by a simple stick. The Israeli's escaped the Egyptian King.

The moral here is that we all have a "stick" to make our way through life's obstacles. We all have our own unique abilities to make it through life, and to make life better. We all have a gift. We all have a unique gift.

It is up to us what we do with that gift. We all have a stick. My stick is my ability to write. My stick is my ability to communicate by words. My stick is my knowledge about respiratory therapy. My stick is the wisdom I've obtained through my life as an asthmatic, as a respiratory student, as a believer, and my experience as a respiratory therapist.

My stick is my wisdom as an American, and as a thinker, a philosopher, as...

Have you found your stick yet?

Why does God let bad things happen?

When someone dies and they are 80 or older, the ultimate soothing words are, "She had lived a long and great life." Yet when a younger person died, the question of "Why?" seems to be more prevalent.

She was only 50 and in the prime of her life. She had a great life, yet she was not finished. She did not get to retire and enjoy the fruits of her hard work. Worse, she did not get to see her grandchildren grow up. Her fruit was plucked too early from the tree.

It's not fair to her. It's not fair to her children. It's not fair to her grandchildren.

The question of the day is: "Why does God let this happen? How could a god who let someone die so unfairly be just? How could a fair God take away someone so young?. How could a God who blessed us for so many years with so much, do this?"

Yet we must remember God does not provide a course for us in this life. God is like the perfect capitalist in that he allows us to make our own decisions and in that way live in a truly free world. God can neither take away nor add to our freedom, only man can do that.

And man has done that. Man has made some pretty horrific decisions, and suffered the consequences. Likewise, man has done some amazing things, and through the course of years the world has become a better place.

We live off the consequences of our actions, and we reap the rewards of our successes. And while God may answer some prayers, he cannot answer them all. Yet by not answering a prayer it is not a reason to think that He is not with you and does not love you.

Many times through the course of History God tried to rid the world of evil, of non rational thought, and of poor decisions, yet he failed every time. In the true capitalist world He created, that's just the way it is. He learned as we learned, and He still learns as we still learn.

He warned Adam and Eve about eating from the Tree of Wisdom, and they did not listen. He wiped out an evil world in the story of Noah, yet the story of the Tower of Babel shows that even while given a fresh start, men have a way of reverting back to old ways, including old ways that were unjust, unfair, and completely wrong.

It is through these stories that we learn that no matter how hard God tries to love us and to help us as we walk through the sands of time in this life, the only real gifts He can give us are spiritual, and include Life, Hope and Faith and the ultimate gift of eternal life.

You can also think of God as a parent. Like we learn from our experiences, He learns. When he was a new parent, he had a bad temper and the punishments he gave were harsh. When he saw most people worshiped false Gods he killed all mankind except for Noah and his family.

When Moses was on Mount Sanai getting information from God, the Israelites created false god in the gold calf and worshiped it, and God told Moses he was going to kill them all. Moses pleaded with God that he had already promised Abraham's children to have as many descendents as their are stars in the sky. He talked God out of killing his children.

In this way, God learned from past experiences. He learned to listen to the prayers of those who plead for mercy, and not let himself get so angry. In modern times he is very humble and very patient with His children (all of us).

I see this is similar to the way I parent. When I first became a parent every little thing irritated me and my first child was punished for things that I would now brush off as unimportant. Since I am in God's image, I am like God in this way. We do what we can with the wisdom we have today, and when we learn better we do better.

So why does God let bad things happen? The answer to that question is that he doesn't let them happen. He has no more control over this world than you and I do.

We must remember that in the Bible (Genesis 1: 26-27) God said, "And now we will make human beings; they will be like us and resemble us... So God created human beings, making them to be like himself."

Since God is not a perfect God, then man is therefore not perfect. Thus, one of the biggest fallacies of all time is that He is perfect and knows all. He may know all that we do, yet he is no more knowledgeable as to what will happen one moment to the next as you nor I.

Think of it this way. You know pretty much all that is going in your world just like he knows all that goes on in his. Yet you have no control of all the individual cells in your body, just as he has no control over all the individual people in his world.

In this way, we are like God, and in His image. We are individuals, and we are flawed.

It's easy to have passionate resignation and to feel anger and hate, even in the Lord, and especially when times are hard like this. By giving us the special gift of life in his image, a life where we are free to live as we please, good things and bad things are going to happen.

Regardless, we must all continue to have is passionate hope and faith, because God's promise for us all, the ultimate gift, is an everlasting life with Him.

We must never forget. We must never lose hope. We must never lose faith. We must live and learn as best we can, and to do the best we can with the gifts we are given. We must love the special people in our lives, and we must appreciate every moment as though it were our last.

We must never stop in our quest to make the world better with each breath we take, with each step we take, with each life we touch, and even with the legacy we leave behind.

"Live as if you were to die tomorrow. Learn as if you were to live forever." Indian Philosopher

Is soul separate from human body???

Many people have experienced near death experiences.

A new study being performed in the U.S. and U.K. will attempt to prove that the human conscience is separate from the body.

He feels a sudden, crushing pain in his chest, left arm, and his chin and fingertips feel numb. He watches anxiously as two nurses poke and prod at either arm with needles. He listens to the audible din of chatter of the medical staff around him, but he can't make out anything they are saying.

His head feels prodigious and his limbs and head feel tingly. In the blink of an eye he feels himself floating above the lights and now the pain, the tingling is gone. He can see the doctor standing at the foot of the bed touching a bare foot with one gloved hand, and holding a chart in the other. "Let's try some Epi," he says.

He watches as the nurse wearing light blue scrubs with Bart, Lisa, Hover, and Marge Simpson plastered randomly over the material inserts a syringe into an IV port of the young, naked man lying on the ER cart. He looks up at her face and spots a middle aged lady with a long crooked nose.

"Are you tired yet?" the Simpson nurse said. She is looking across the naked man at a man so young he didn't look like he belonged in this room. This young man, however, had what must be the most important job of all: he was performing chest compressions on the naked man. "I'm fine," he said.

This young man was wearing a white lab coat over navy blue scrubs. He had a finely combed and thick head of hair and his name tag read "Jeff...student Respiratory Therapist."

Jeff's head bobs up and down with the flow of his hands thump, thump, thumping on the chest. Our conscience now travels down Jeff's arms, to his hands which are pressed together between the naked man's nipples. Looking up beyond the neck, we can make out a head with a mask over it and more hands over the mask.

As our conscience is about to take a peek at this person's face, everything goes black. Now we see a spiralling tunnel that seems dark at first, and then we see a light. There seems to be a sense of joy -- euphoria -- as we get closer to the light

Suddenly we see two forms near the light. As we get closer we can see that those aren't just any forms, but those of people who look familiar.

Then everything goes black.

That's how it stays for a long time until later the next day he wakes up the next day to the din of beeps and soft chatter. He tries to speak but cannot. He has a tube in his throat. He feels like he has to pee.

Weeks later he is sitting up in his bed and a young student RT enters his room. "I remember you," the patient said.

"You do?" the student says.

"Yes. I remember you were doing CPR on me."

"You remember THAT! How could that be?" He seemed excited.

The patient explained in explicit detail the events that occurred WHILE HE WAS UNCONSCIOUS and experiencing his NEAR DEATH EXPERIENCE.

This is a very common scenario.

Scientists are now placing in random hospitals a shelf very high in emergency rooms where similar events such as this might happen. And they are placing objects on those shelves that are impossible for any human to see.

So, if a patients wakes up from a near death experience and is able to identify the contents of those shelves, scientists will have proof that the conscience -- the soul, the spirit -- is a separate entity from the human body.

Depressed spouses make themselves sick?

One of the most frustrating things I see in the hospital is when we have an older patient whose spouse just died and the couple had been happily married for over 40 years. We had one man recently who was a very successful member of the community even up until recently.

However his wife died a couple weeks ago, and then he became so depressed he ended up a permanent fixture in the hospital. He got pneumonia, he refused to eat, his medical condition deteriorated, he ended up on a ventilator, and he eventually made it back to the floors and continued to be a depressed mess.

I tell you I have the utmost sympathy for people in this situation. However (and I'm no expert in this area other than by mere observation as an RT), I wonder if they have their priorities straight. I know lots of people who were happily married, only to live on for many glorious years after their spouse passed on.

I consider myself happily married, but I sure would hope that if I passed on that my wife would go on with her life after the initial mourning process. I mean, I know their is nothing more difficult than losing a loved one (especially a child), but I can't imagine the one who passed on would want his best friend to spend the rest of her life mourning.

Being old and being fed up with going to the doctor, about being blind and deaf and having to tackle a million prescriptions every day is one thing. I know when my uncle Donald died recently, I was told he had simply decided he had enough, and then he got his wish a few days later. He was 92.

I understand that. But to be of good health, sound mind and body, and to simply give up living, to me, is a foolish thing to do. And, I might wonder, if that person didn't have his or her priorities in life mixed up. I rarely do this in real life, but I would like to ask these people some questions like:

1. Do you believe in God?
2. Do you place God ahead of your wife?
3. Do you have children?
4. If so, do you prioritize your yourself over your children?
5. Do you have hobbies that you like to enjoy that you can still do?
6. Were you so attached to your wife that her love was the only quality thing in your life?
7. Do you have quality friends?
8. If so, do you place your grief ahead of your quality friends?
9. Do you not care that you are setting a bad example for the ones who still love you?
10. Do you not think you are letting your freinds and family members down by giving up?
11. Do you not care what other people think?
12. Do you realize people feel sorry for you?

Sometimes, when I have time, which often I do here on nights (but not lately), I talk to these patients. I ask them, in an appropriate way (and only when they bring up the topic), the above questions, and sometimes I get them to participate in an intelligent discussion during the treatment. I get them talking about how wonderful his wife was, or career, or something.

And, more often than not, I get a smile. The reason, I think, is that, even while he is depressed, he doesn't want to be a stick in the mud; he doesn't want to share his depression; he understands that there are other people (like me) who still have several quality years of life left.

So they smile. And, I bet more often than not, they eventually recuperate. I bet most of them do. But, unfortunately, some never do. These people become permanent fixtures around the hospital and nursing home arenas. They are the ones who demand attention, ring their call bells every 15 minutes chanting to whomever answers the call with: "Get me this," or "get me that."

Those are the lucky ones. Those are the ones who are still willing to talk, because some of these individuals are so depressed they just lie there and sulk. I feel bad for them at first, but then after a while I wish they would just quit feeling sorry for themselves. I wish they had other priorities in their lives other than the one they lost.

I wonder if they do believe in God. I wonder if they do believe in heaven. Because, as I wrote before, I believe that people that have their priorities together are the best patients. In fact, I bet most of these people don't get sick and avoid the hospital altogether.

I'm no expert in this area, yet here I am just wondering.

Not working hard and appreciating it

I woke up early today, and the first thing that popped into my mind was the image of a little boy we had taken care of a while back. I decided as soon as I got to work I was going to check on him via his mother's blog.

Now here I sit. It is freezing cold here in the RT cave. Even with the thermometer turned up to 85 I can still feel a draft coming from the window. And, considering we only have seven patients on our RT list, I have plenty of time to sit here at this computer, which sits on a table right in front of that window with the draft.

Seven patients seems like a lot these days, considering when I came in Thursday night we only had 2 patients. By the end of that night we were up to a whopping three patients, the third of whom actually took up some of my time during that night, but it was still a major task staying awake by morning.

Last night our patient load escalated all the way up to four, but two were QID and one Q4 W/A, so I ended up not giving any of them treatments all night because I'm certainly not going to wake a patient up whose sleeping comfortably. So, what I ended up with was a hell of a lot of time on my hands.

By six in the morning, after spending the majority of the night right here completing some projects and, of course, just a little blogging, I was feeling very sleepy. This wouldn't bother me so much if I were actually doing something, but since I was sitting around so much I needed tooth picks to keep my eyes open, and what I looked forward to more than anything was going home for no better reason than to give my butt cheeks a rest.

I really haven't had an interesting case worth writing about lately, which is unfortunate because I have the time to write. The ironic thing is, if I worked at a larger hospital like some of you other RT and RN bloggers out there, I'd probably have many interesting cases to write about, but no time to write. So, I suppose, that's life.

Last night around six, eyes burning, I slouched back in a chair behind the critical care desk and had a real philosophical discussion about God. It seems when you are most tired, like say after 2 a.m., is when these discussions occur. The discussion seemed really enlightening at the time, and I thought I might write about it later, but, for the life of me, I can't remember the details.

Oh, I suppose this might have something to do with the fact that at around 6:30 it seemed the discussion rested mostly between my two RN co-workers, and I decided to rest my eyes a minute. I will do this just a few minutes, I thought, and then I'll go out and do my QID treatments."

I opened my eyes and looked up at the clock: it read 6:55. My co-workers were still rapt in their discussion. I don't think they even had a clue I had fallen asleep.

Here I sit; the cool draft causing me to shake slightly as I click away these words. I'll eat my lunch soon, finish off my two treatments, and then I'll end up right back here for a few hours unless the emergency room finds other things for me to do.

And I feel fortunate nonetheless. When I have nights like this, at work, I think of how many 18 hour days my dad put in, and his dad before him. And I think how many people have sacrificed their lives over the years so I can have this. I thank them.

Thinking of this makes me appreciate all the more how wonderful a life I have, especially to have a great job like I do.

This reminds me of the little boy again, so I clicked on his mother's blog.

He was transferred from out services to the Big City hospital and placed on an ECMO machine within a few days. If you're not familiar with ECMO, that's a machine that removes the blood from your body and oxygenates it, giving your lungs and heart a rest and time to heal.

She wrote how she was informed by the doctors that there was a chance the boy would survive, but it would be a long and difficult road.

Going on an ECMO machine is nothing like the ECMO machine used in an episode of ER that I watched two nights ago, where the patient was put on an ECMO machine right in the emergency room and taken off five hours later. This boy's doctor said it would be a minimum of three weeks.

I know very little about ECMO other than what I was taught in a brief two hour lesson when I was in RT school. I did see one once when I was an RT student at a large University pediatric hospital in our state, and what I remember is a roomful of machines, IV's and other machines and, right in the middle, this tiny patient.

In doing my research, I learned that there were other children who had swallowed kerosene and survived. Two I read about were placed on ventilators, and another was on an ECMO, and all three of them survived.

This mother was well aware of this, and this gave her hope.

I read today the child passed away.

Now I didn't know this child, as I don't know probably 99% of the people who walk through these doors, but it's very nice when a family keeps us updated on people we cared for, even patients we stabilize in a few short hours and ship out.

While I feel for the child, and especially the mother, this situation acts as a reminder to us all how fragile life is. It provides me a greater appreciation of how wonderful a life I have, and how great a job we have, even while I sit here freezing.

Asthmatics can be normal and have fun too

If all goes as planned, today's the day I get back in the swing of maintaining a sound mind and body. While it seems a ton of people make this their New Years Resolution, it's something we asthmatics have no choice but to think of, though I'm not necessarily the best at it.

Last summer I let myself get out-of-shape, so in the fall I started doing the Body for Life workout program. Which is one of the reasons it didn't make sense that I got sick last month, because I was being 100% healthy at that time. Go figure, hey.

When I was released from the hospital after being diagnosed with a duodenal ulcer, I felt vulnerable, and was going to do whatever I needed to keep my body healthy.

However, while I was recuperating, I wasn't really able to hit the treadmill, especially considering my hemoglobin was low. And then, once that period of vulnerability wore off, I started eating normal again. So now I'm starting to feel out-of-shape once again.

I like working out. I love how good it makes me feel. However, when I stop for whatever reason, say a vacation, a holiday, or, as was the case this time, a hospital stay, I find it easier to stay off the wagon than get back on, and I end up feeling like a do today -- sluggish.

I don't know if this is the case with normal people, but when I go so long without getting any aerobic exercise, I start to feel winded -- not short-of-breath as in bronchospasm, but simple windedness.

I observe some obese people I meet being winded as they walk, but I don't think that's the norm. In fact, I'm convinced it is not. So, when I see someone winded like that, I think chronic lung illness.

How can these people live like that? How can these people stand being winded all the time? I hate it, and that's why I work out. I'm definitely not muscular, and I'm definitely not skinny, but I'm definitely not obese either.

I have learned, both via asthma eduction when I was a kid and the hard way after I failed to listen, that excersise makes your lungs work better. It's true. It really works. It may even make your asthma better.

This is one reason why having asthma might be good for me, and why I don't regret having it. Because it forces me look at things from a different angle.

It forces me to at least keep trying to get my body in shape. And one good thing about having a stomach ailment is that it forces me to limit what I eat. Sometimes I wonder if perhaps God gave me these ailments for this reason -- that, and the fact I have the ability to share my experiences with other people.

I come from a family that loves to eat and drink and have fun when we get together. And I've never been shy about joining in. It's fun. However, one thing that people with asthma have to be aware of is this: alcohol dries out your lungs. Usually, on the day after drinking, I have at least some trouble with my breathing.

When I was younger and still participating in the bar scene, I used to blame this on the smoke. Now I know it's not just the smoke that caused this, because no one smokes around me when I'm in my home. So, if I'm using my Albuterol more than usual the day after drinking, I know it was the alcohol that caused this.

I wonder how many asthmatics don't know this. Most asthmatics, like most COPD patients, learn this by trial and error. Some people never learn, and continue to suffer.

Now that I'm an adult, it's easy for me to avoid things that I know will bother me. Sometimes, however, I intentionally walk into enemy territory because I want to be normal. I'm allergic to my brother's house, for example, but I went there recently to socialize, to eat, to drink.

I got the sniffles. I had the prototypical mild windedness the day after due to the alcohol and whatever I was allergic to at his house. But I had a great time none-the-less. While I try to stay away from irritants, I don't want to live in a bubble either.

In a previoius post, I wrote about how when I was a kid I used to play football despite the fact I'd be having an asthma attack. I did this because I didn't want to let my brothers down, and because I wanted to play football; I wanted to be normal.

I don't get that bad anymore, but then again I don't play football in the cold anymore either. And I have adult sized lungs, am compliant with my medicines now, and have a good routine of preventative medicines, which is why I don't have so much trouble when I rough house outside in the cold with my kids these days.

When I was a kid I remember wanting to be just like my dad, but my dad never once had to think twice about what he needed to grab or avoid in order to go camping. I still envy him for that. And when he took me with him once when I was a kid he had to take me home before midnight because I was so miserable.

Later I learned I couldn't be normal like my dad. For years, when I left the house, I had to make sure I had all my medicines, and especially my rescue inhaler. And no one but me would be thinking this way. It was just something I had to learn on my own.

Likewise, I had to be thinking of where I would be going, because I had to prepare for the worse. For example, if we were planning on going camping, I had to make sure I took something for allergies -- just in case.

I no longer have to rely on my rescue inhaler so much today because I know what places to avoid and we (RTs and doctors) know a lot more now about medicines that allow asthmatics to live normal lives.

And I've learned that there is only one person who knows when I'm entering enemy territory, and that is myself. No other person will notice the warning signs but me. While I'm aware of this, I think this is a major challenge for other people with pulmonary illnesses, particularly people with adult onset asthma or COPD.

Me, I've had this all my life, and when I realized I had to make life changes, it was easy for me because I was young. I bought a new house instead of an older one with allergens. People know not to smoke within a mile of my house. I learned to excercise and eat right, and got into the habit of it (well, sort of).

However, for others, I can see how hard it would be to change their surroundings.

When I was a kid doctors and scientists weren't sure about the safety of keeping asthmatic kids on steroid inhalers, now they know they are safe. And, by using the appropriate preventative therapies, there is no reason any asthmatic should not live a normal life.

When I was a kid I never tried to get out of anything because of my asthma, as my football experience should prove, but I did get out of physical education classes in high school. Now-a-days, there is no excuse for asthmatics to not excersise. Jackee Joyner Kersee has asthma, and it didn't stop her from participating in the olympics.

If you can't run, then you can walk, like the Bay City Walker, if nothing else.

Asthmatics can be normal and have fun too, they just need to pay attention to certain things, that's all.

It's good to have fun. I could not imagine going through life without social gatherings that involve a lot of great food and drinks. And I couldn't imagine going through life without relaxing at the end of a long day with two or three nice cold beers, or a glass of wine, or a whisky and diet soda. Those are just some of the things I enjoy.

We all get out of shape. We all have bad habits. But it's especially important for those with chronic illnesses to do some form of exercise, and to at least pay attention to what they eat, even if it isn't always health foods.

But, as with most people, there comes a time when the "get the body back in shape" mode comes back on. That day, if all goes as planned, is today.

I'm going to do this. I have to do this. And, as usual, it will probably last for about three weeks, at which time I'm going on vacation in Florida. When I get back I'm certain to have trouble hopping back on the wagon.

That's normal, I bet.

Good patients go to be with the Angels

Patients who believe in God are often far better patients than those who don't. This is a theory that my friend Sin over in the CCU Cave and I discuss once in a while. And more often than not our patients prove us right.

Last night was a perfect example. I walked into a patient's room to give him a breathing treatment and he said, "I don't want that damn thing." He flailed his arms and tried to hit me.

I was blunt with him: "I have kids that behave far better than you do."

I left and charted a refusal. I don't care if he was short-of-breath or not. Fortunately for him he wasn't SOB, but he did have a harsh, audible, prolonged and forced expiratory throat wheeze when he was all worked up, which he was at that time. And for that reason the patent's nurse, Wren, called me to the room.

"I think he really needs his treatment," Wren insisted.

I studied the patient again. "What he needs is s spanking."

"You shouldn't talk like that in front of the patients."

"This guy isn't having anything close to bronchospasm. He sounds bad and that's about it. Even his doctor told me he's like this at the nursing home. As soon as he calms down he'll fall asleep and he'll be just fine, just wait and see. And if you guys just leave him alone he will calm down."

"Why don't you just give him a treatment?"

"Because I have patient's who want my services and I'd like to live to give them. I'm not going to stand there and risk my life and force a treatment down someones throat when he doesn't want it or need it." My voice trailed with that last part.

"All you have to do is put a mask on."

"And he keeps ripping it off. The day RTs gave him a blowby all day, and he won't even tolerate that now. Besides, like I said, he keeps trying to hit me."

I paused a minute while she tried to insert her syringe into the IV port, and the patient jerked his arm away. "GO AWAY!" The patient ordered. I grabbed his arm forcefully and held it down while she did her job.

"See what I mean. I'm not trying to be mean, it's him. I know this guy, he's been here all weekend. I've studied him. Trust me when I say he's not short-of-breath, he's simply anxious."

Wren smiled. "I see."

Later on we had time to discuss the patient, and laughed. I told her about my God theory and she agreed with me.

Later in the night I visited Sin who took care of the patient a few days earlier, and Sin told me he had a tryst with the patient, who shouted, "I don't have no use for your f#$%ing God! Get the F#%^ out of my room!

Sin said, "He has no reason to be good. He didn't believe if he was good he'd go some place good, like Heaven. There's no incentive for someone like that to be happy at the end, so they take it out on everyone around them."

"So you're saying he's scared."

"Yes. And people who believe they are going to Heaven do not get scared. I mean, they get scared, but you know what I mean."

"Yep, I agree with you."

"Whether you believe in God or not, it's a proven fact that people that believe in God, for the most part, are good as Angels. And I think most patients fall into this category."

I told him my favorite end-of-life stories are when people go out still doing something they love. I remember this one lady who loved doing Genealogy, but her computer broke down just prior to her coming to the hospital."

"Do you know how to fix computers?" she kept asking me. She was in CCU and I know she knew she was going to die. Doctors told her her heart was going to give out any time. She was cheerful and happy as ever. And she simply continued to work on her little projects.

I know they say it's not good to get close to your patients, but I'm telling you that's not always possible, especially when they are so sweet and innocent.

My grandpa, I was told, checked out while he was making a to-do list.

Many ladies whittle to the end. I'll never forget this one long-time patient of whom I participated in many interesting conversations. A couple days after she was discharged I was called to the front desk. Her husband was there holding an afaghan.

"She wanted you to have this," he said. I smiled and waved to her out in the car. I didn't have time to visit at that time.

A few days later I read her obituary. I think of her every time I use the afaghan.

I see many terminal patients reading books. I think, "What more could there be for you to learn? What good would this knowledge be?"

I know the answer now. God can use the knowledge.

At the funeral of a my wife's uncle last spring, his son spoke through tears and said his dad gave him a book in which the author claimed to have studied the Bible and was convinced that "what we learn in life we use in Heaven."

He said, "I guess God needed a carpenter. I'm sad that it had to be my dad, but I'm happy for him too."