Its Saturday morning and what looks to be the beginning of a beautiful day through the windows of my sunroom. I don't blog about work much, but today some reflections are running around in my head. Tim works in CVT, an open-heart unit. I manage a Medical/Neuro ICU. I often do brief educational sessions on strokes. I tease in my classes about which matters most the heart or the brain. The brain is why we breathe, why we move. Its where we hold our intelligence and our memories. Its why our heart beats. Yet our brain wouldn't work without good oxygen rich blood that is pumped to the brain by the heart, so kind of like which came first the chicken or the egg. The brain tells the heart to beat, the heart beats the oxygenated blood to the brain. A broken heart (literrally not figuratively) affects the whole body and the brain. A broken brain affects the heart and the body as well. Are they equal? I guess that answer depends on who you are - a person who has strong beliefs about one's spirit and soul or if your a scientist and don't put much stock in feelings.
We equate so many of our emotions with our heart - love in my heart (feeling of euphoria), a broken heart (feeling of sadness), anger in ones heart (feeling of anger and frustration). Yet in truth, these feelings and emotions are created in our brain and the actions stimulated from these emotions are again products of all the activity in our brain. The smiles, the laughter, the tears, the sadness - all comes from an area of your brain.
In healthcare, when a patient has a heart attack and dies, we generally are okay with the thought that the persons spirit and soul have gone to heaven at the time the heart is no longer beating. And I think for any of us, we look for that certainty of when death is. The person is no longer breathing and the heart is no longer beating. As nurses, we are trained to assess for these two things to determine that the patient is dead. So, that certainty we are looking for, is it the time written on the death certificate? If your reading this, your wondering if I am crazy, I'm sure. But when someone is brain dead, death goes against our training because they are still breathing and the heart is still beating, although artificially. When you have a patient who is brain dead or seemingly, but it is time between brain death testing that is the hold up, so what is the time of death? When we stop the ventilator and the heart beat stops on the monitor? That is what will be written on the death certificate. Is that when we truly see the heart is no longer beating, that we have proof that ones spirit is now gone to heaven? The truth though is that when the brain no longer functions, it is artificial means that is keeping things on the monitor. So, here is a far fetched thought, we dont' get emotionally attached to machines or equipment, yet its okay to get attached to the ventilator and monitor?
To summarize - if nothing else - for myself.....We need our brains to direct all the things we do and are. We need our heart to pump good oxygenated blood everywhere. Sometimes our heart (supposed emotions) and our brain (logic) do not agree. We think our heart says do something , yet our brain says don't. We have a heart attack and die, our soul goes to heaven. Our brain dies and perhaps at the point when it herniated, that is when our soul goes to heaven? As a nurse, I would think that. As a family member, I would hold out that when the heart is no longer beating on that monitor, the soul is then released. But the challenge of getting a family to understand that its just an empty body, a body that without brain functions is not compatable with life is touch. I guess we hang on to the fact that as long as the body is still warm and the heart is still functioning that the patient is still with us to touch and see. Once gone, those simple things are no longer available. As a loved one, I would want to touch that warmth and hold on as long as I could, yet if I knew that the soul was gone to heaven at an earlier point and if I knew that the body's warmth was just fake, would I get to acceptance of death sooner? Hmm? so perplexing. Death is never easy. I can't help but think though that a heart attack related death is so much easier on the family because it is so much more definitive. Brain death - not so much.
And then - what if they become an organ donor? If the heart is transplanted, we as a society believe that our loved ones spirit lives on. But the truth is, their memories, personality and identity died when thier brain died. Yet, an organ donor is always a hero and thank goodness that their are those that are giving and unselfish and want to help others in need. Just like money, you can't take it with you. Why don't people donate? A whole different blog! :)
Enough about this subject of death. A reality of life. A reality that nurses deal with. For this one, an emotional ride as I see the young patient, I see the clinical reality, yet the sadness and strong HOPE and faith in the wife and family. Miracles do happen, but still an internal struggle for me. Could you tell?