The Israeli and and international media and physicians themselves are raising serious questions about Ariel Sharon’s medical care. Haaretz in particular has run several stories, including one today, covering this angle. The questions that concern me most are:
1. Was there a real medical need to do a heart catheterization to repair the hole in his heart?
Some doctors maintain that the heart defect allowed a clot to travel to Sharon’s brain causing his first mile stroke. Other doctors say the cause of that stroke is unclear and that the heat operation (along with the prescription of blood thinning agents) was overaggressive care which in this case may’ve led to his current near-death state:
A number of physicians told Haaretz they wondered about the wisdom of performing the heart catheterization on Sharon. The prime minister had been advised to undergo the procedure to repair the birth defect of a hole in his heart through which doctors said the blood clot had traveled to his brain and caused the first stroke. But Professor Martin Rabbai, head of neurosurgery at Assaf Harofeh Hospital said the heart catheterization was “not recommended,” since it had not been proven that the blood clot moved through the hole in his heart to his brain. “On the contrary,” Rabbai said, for a man Sharon’s age “it is advisable not to touch it.”
2. If the heart procedure was necessary why did they wait so long to perform it?
If it is true that the heart defect caused the first stroke wouldn’t it be possible that it also caused his second stroke as well (along with the blood thinning medication which can cause massive bleeding if a blood vessel tears). If so, then why wouldn’t doctors have performed the procedure immediately?
3. If Sharon’s prognosis now is very poor as many medical specialists concede, why are doctors making such heroic efforts to save him?
A senior neurologist called the second surgery performed on Sharon on Friday “unnecessary,” citing research that surgery under such conditions does not improve the patient’s prognosis. The neurologist said he believed Sharon was suffering from ‘VIP syndrome’, “that out of a desire to help a senior public figure physicians do things that might be unnecessary and may carry potential risks.”
A senior neurologist at a major Israeli hospital said the first surgery was “heroic,” because most patients with such bleeding would not be operated on, “but I understand they did so because it was the prime minister. At some stage you have to think if you want to leave a patient in a terrible functional state to save his life.”
I understand the need for doctors to show they’ve done everything they can to save Sharon’s life. The nation expects no less. But there must come a time when everyone, from his physicians to his family to the nation must recognize that though Sharon was a larger than life figure to all, he was still only human. And every human being deserves a right to die with dignity. We all need to go when the moment is right. Perhaps that moment is now.
Do we want an Ariel Sharon to survive in a near comatose state? What purpose would this serve? Would it assuage the consciences of doctors or his sons who feel the need to do everything in their power to keep him alive? What’s the point other than fulfilling our own needs? What about the patient’s need perhaps to die?
Haaretz notes that Sharon did not institute a Do Not Resuscitate (DNR) order. This is another reminder to all of us to create living wills and let our physicians and loved ones know our wishes so that our medical care adheres to our own approach to death.
As Kohelet says: “There is a time for living and a time for dying.” God grant us the insight to recognize when the time is right to go.
It’s fitting to close with Zelda’s spare, brilliant poem, Each Man Has a Name. Pay special attention to the final verse:
Each man has a name
given him by God
and by his father and motherEach man has a name
given him by his stature and his smile
and given him by his clothesEach man has a name
given him by the hills
and given him by his wallsEach man has a name
given him by his fate
and given him by his friendsEach man has a name
given him by his sins
and given him by his yearningsEach man has a name
given him by his enemies
and given him by his loveEach man has a name
given him by his celebrations
and given him by his workEach man has a name
given him by the seasons
and given him by his blindnessEach man has a name
given him by the sea
and given him
by his death.
(translation, Karen Alkalay-Gut)
Let us in death give Ariel Sharon back his name.
Good call, Richard. It’s pretty obvious Sharon is an atherosclerotic nightmare – a patent forman ovale (the “hole in his heart”) is the least of his problems. That’s something I think about in a 35 year old who has a stroke – not an 83 year old who weighs 300+ pounds.
The real medical scandal though is that they put him on heparin after his first stroke – an anti-coagulant or blood thinner. That’s definitely not the standard of care for someone with an ischemic stroke. In fact, the danger is that the patient can hemorrhage into the area of the initial stroke, which is exactly what Sharon did. Plus, he was at his ranch, not at a hospital where the heparin treatment could be properly monitored.
The strange thing about treating ischemic strokes is that the best thing you can do is nothing. You give the patient an aspirin, and keep an eye on him to make sure he doesn’t aspirate. That’s it. Anything else is likely to do more harm than good.
Unfortunately for Sharon, the medical standard of care isn’t politically palatable. I think his doctors needed to show they were doing something, everything – so, they did too much, took unnecessary chances, and he suffered the consequences.
I’ve always felt that wealty, powerful people get substandard care for exactly that reason.
I won’t shed many tears for Sharon. But I’m suprised that his doctors let politics so badly skew their medical judgment.
I should add that my esteemed blogger friend, Andrew is a general practitioner (is that right, Andrew?) with a medical practice in Massachussets.
Victoria2: I’m not sure I’d say to a medical certainty that his chances of recovery are “zero.” People who’ve been through trauma sometimes remain in comas for a very long time before they awaken. Also, I understand that there is brain function. So it doesn’t appear he’s in a vegetative state.
But if Sharon were in a coma, Judaism is generally against heroic measures like artificial respirators or long intubations. Life is an intrinsic value only in that it enables us to do good deeds. Life is a means to an end, but not an end in itself. Our view of life is not that of the anti-abortion folks as represented in their circus over Terry Schiavo.
That being said, there are no hard & fast rules as to how to proceed. It’s left up to the family to decide as it sees best.
There has been media coverage about Sharon’s medical condition & the controversy surrounding it in Haaretz. This is but one of many articles it has run on the subject.
My understanding is that Sharon is not on a respirator, but is breathing freely on his own.