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Richard C. Senelick, M.D.

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Would You Choose to Live After a Catastrophic Injury?

Posted: 03/17/11 10:10 AM ET

It seemed like a routine day. I had just finished speaking at a meeting and I had a few hours before I needed to head to the airport. The next speaker was lecturing on how to wean a quadriplegic patient off a ventilator. I was only half-interested in the topic and wasn't giving it my full attention.

After a very brief discussion on the mechanics of weaning, the lights were lowered and we were asked to imagine lying in the dark, totally dependent, with only the sound of the ventilator, whoosh-whoosh, whoosh-whoosh, whoosh-whoosh. Imagine being unable to scratch the itch on your nose -- waiting for the next whoosh that would signal that your life support was still functioning.

The lights came on, and seated before us was an elegant, stylish woman in her 30s. Her blond hair was cut short and striking. She had a radiant smile that immediately warmed the audience. Her fingernails were perfectly manicured with bright red polish, but they were motionless, supported by the troughs of her specially-fitted wheelchair. She was motionless -- not by choice, but by bad luck. Pam, a high-level quadriplegic, had quite a story to tell.

A Life Worth Living

At 34 years old, she was an accomplished registered nurse who had recently moved to to be near her mother. As she hurried off to work one day, she forgot to fasten her seatbelt. Her car skidded as she hit the slick pavement, and the next thing she knew she was on the floor of her car, unable to move her arms or legs, awake but helpless. She instantly knew that she had broken her neck and she was in big trouble.

Pam was placed in the intensive care unit, paralyzed from the neck down, with a tracheotomy in her throat and her life dependent not only on people, but on the breathing machine with all its knobs and dials that unceasingly went whoosh-whoosh. The sound was unrelenting -- no silence, no quiet, no peace. But worst of all, she had no way to communicate. What she wanted most was for someone to stay by her side and help figure out what it was that she needed. The time between nurses coming in to check on her seemed interminable. When they did come, it was to adjust things, not to take a moment to find out how she felt. Did she need her nose scratched, her hair brushed out of her eyes, the light turned back on or off? They told her that she might never breathe on her own, and it was at those times that she thought about dying.

The movement in her arms and legs never returned, but she was able to build her strength to the point that she tolerated more time away from the whoosh-whoosh. She spoke triumphantly of the first time her tracheotomy was capped and she was able to speak: "If I could speak, I was back and I wanted to live. My voice is me. With the sound of my voice, I knew that not everything had changed. I wanted to live more than ever."

With speech came the ability to direct her life. She could tell the doctors and the nurses that, despite being paralyzed, she was the same Pam -- the same bright, articulate woman as before; no less a person just because she couldn't move her arms and legs; no less a person because she was dependent upon them for care and sustaining her life.

Why Do We Want To Live?

I suspect that there are many people who look at someone like Pam and ask whether or not they would want to live if they were in the same situation. Many people say they would want to die, but are we really capable of making that decision before we are confronted it? Pam is the perfect example of "resilience" -- the capacity to positively cope with stress or adversity.

A recent article in Scientific American, "The Neuroscience of True Grit," looked at the science behind our ability to bounce back from significant stress or trauma in our lives. The research tells us that the ability to get back our equilibrium and our will to live is the "norm," and it is only a small percentage of people who experience significant difficulty adjusting to their trauma or disability. They refer to this phenomenon as "coping ugly" -- adapting to most of the adversity that life throws at us. In other words, resilience is ordinary and not extraordinary. It does not mean that we will avoid emotional pain and distress while experiencing or recovering from the event, but the vast majority of people will return to their equilibrium.

Part of the current discussion is about whether we are "hard-wired" to be resilient, or whether it can be taught. Is it a process or human trait? The military has a great interest in this, for if we can modify someone's resilience, then it would be advantageous to either pre-treat soldiers headed into harm's way or aggressively treat them once they are injured. However, the "true grit" article points to studies that suggest that interventions are either of no value or interfere with the normal recovery process. Left to our own devices, the human psyche will usually have a natural resilience to catastrophic events in our lives. This supports the theory that the "wiring" in our brains keeps most of us from spiraling down into severe depression and returns us to a state of stability.

What Favors Resilience?

Even if resilience is a natural phenomenon, many people need help along the way. The American Psychological Association (APA) uses the analogy of a raft going down a river that encounters "rapids, turns, slow water and shallows." You need a plan to navigate the river and you may need to get help from others to complete your journey. The APA tells us that the journey is easier for those who have the following:

  • Supportive and caring relationships
  • The ability to see a solution to their problem and a realistic plan
  • A positive view of themselves and the belief that they will be able to manage their feelings
  • The ability to see themselves as a survivor rather than a victim
  • The capacity to manage strong emotions

Each of us will have a different journey and "pack" differently for the trip. The good news is that 90 percent of us end up at the destination with a will to live and a desire move forward in our lives. Very few of us escape adversity in our lives, so take a moment and do an inventory to see if you are prepared for the journey.

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