Moribund

This film is dedicated to all patients, their families, and the physicians and anesthesia providers who care for them. It is the second in a series of "edutainment" videos designed to stimulate thoughtful discussion about important topics in anesthesiology (and medicine in general). This video addresses end-of-life issues, specifically those which present in the perioperative setting. Anesthesiologists and surgeons are frequently confronted with complex ethical dilemmas, and it is difficult to separate our own emotions and spirituality from the situation at hand. Perhaps even more compelling is the fact that physicians, in general, seem to be uncomfortable in talking to their patients about end-of-life pathways and palliative care, despite data which indicate that patients and their families both desire & benefit from these discussions (regardless of which decisions are made). These difficult situations evoke a complex array of deeply held emotions, religious and spiritual convictions, and cultural influences within ourselves, our patients, and their loved ones. There are also racial and ethnic differences which influence end-of-life preferences, such as language barriers, miscommunication & mistrust of our health care system, and the reported undertreatment of pain in these populations. A study of 332 terminally ill cancer patients, who later died, revealed that only a third recalled discussing end-of-life issues with their physician, and those who did were more likely to enter hospice, fill out a living will and/or a DNR, and were no more likely to feel depressed, anxious or afraid. Those who did not engage in an end-of-life discussion were more likely to be admitted to an ICU, be placed on a vent, or undergo a resuscitation; in general, they reported a worse quality of life. Are physicians inadequately trained in this type of communication, or are we unresolved with our own personal beliefs regarding death? Perhaps it is a little bit of both..."we owe it to ourselves to ask, to consult, to be courageous and proactive, to explore all possible alternatives, to acknowledge our limitations, to reach an understanding through careful deliberation..."

The idea for the song, "Moribund", arose from a discussion during an anesthesia morning conference. An anesthesiologist colleague received a moribund patient from the ICU, who was having a cardiac arrest en route to the OR. Despite efforts to surgically repair the patient's dead bowel, the patient expired a couple of days later. The question arose: "Should we have operated on this patient in the first place?", especially given the fact that other services had begun to withdraw care. This song is NOT intended to question a surgeon's decison to operate on a critically ill patient, nor it is intended to single out an ethnic or racial group. Instead, it is meant to question our current system of physician education in medical ethics and decision-making, along with our current practice of broaching end-of-life topics with our patients.

The music was inspired by a familiar Motorola pager noise (the "arpeggio" or "pleasing alert #4"). The melody is punctuated by the drone of the pulse oximeter, and has a haunting and lonely quality. I wrote the lyrics. My son, Nick, and i wrote the music, and he mixed and mastered the mp3. My other son, Rory, is singing along with me. It is purposely fuzzy and static-y, as if being heard over a telephone or a radio, mainly because I am not a singer and felt self conscious about my voice. The young man who plays the patient, and his family, are friends of ours, and they enthusiastically volunteered to be a part of this project. Of interest, both of my sons have cystic fibrosis...our family has chosen to acknowledge death as an inevitable part of the life cycle, to make our wishes known, and live our lives passionately and "in the now."