applestem

applestem t1_j4xwz7x wrote

Reply to Family Dynamics and Doctors' Emotions Drive Useless End-of-Life Care. Surveys repeatedly indicate that nearly all people would rather die peacefully at home, yet painful, long-shot treatments remain common, and efforts to reduce usage have failed by Wagamaga

My Dad was 91. He had experienced a dizziness spell in the summer, but otherwise was mentally alert, very involved in a number of social activities. However, he didn't trust doctors and attributed the dizziness to a steroid for a sore shoulder. He didn't follow up. We kept telling him to see a doctor. A couple months later, he suddenly had severe shortness of breath and went to the ER. My brother joined him, and after the ER doctor asked, Dad said to perform any life-saving interventions necessary. I arrived later that day.

Well, it turns out that he had a major heart valve that was not opening completely, leading to vastly reduced blood flow. He had lung blood clots. His liver was non-functional and his kidneys were shutting down.

They took him to the ICU to get ready for a heart valve replacement, but the dye necessary to perform the procedure would cause his kidneys to fail. He was also suffering from congestive heart failure, with fluid buildup around his lungs. They needed to give him fluids to try to restore kidney function, but a diuretic to reduce the fluid build up. He was suffering from air hunger so he was mildly sedated. He would not eat.

He had a living will, so finally the ICU nurse, a hospice nurse, a hospice doctor all met with me and my brother. We asked to move him into hospice. We couldn't take him home because at the rate he was declining, we couldn't get the care, bed, oxygen, etc set up quickly. He was quickly moved to hospice.

He had a quiet room with a view of the water in the area he had grown up in. He had just a catheter, oxygen and a line for the morphine to ease the struggle to breathe. They shaved him, cleaned up, combed his hair and made him comfortable. He was always impeccably groomed so I know he would have approved. He hadn't been conscious for a couple days, but was resting quietly.

It was Thanksgiving day as my brother and I sat with him. Since he was no longer able to object (he was a proud and strong man), I had some friends come to say their good-byes. As we left, I said goodbye and that I loved him and would be back tomorrow. Shortly after midnight, the hospice nurse called and he had quietly passed away. I drove, picked up his stuff, held his hand and said I would miss him and left. I was kind of numb, but he had passed without pain

Did I have second thoughts? Of course, I did. Maybe we could have done the procedure and then gone onto dialysis. Maybe the fluid buildup and clots would have resolved with a restored blood flow. Did we give up too soon? Should we have tried to move him home? He was no longer conscious when we made the decision to withdraw treatment. Would he have approved? He opened his eyes for a bit that final afternoon at hospice, his mouth was no longer slack and he just looked out at the riverscape and said nothing. Was he aware, was he upset? I talked to him, but got no response. Should I have stayed that evening so family was there when he passed? I just don't know. He was not in pain, and I know that he went peacefully.

Hard as it was, I believe it was the right thing. His body had failed and marvelous as our medical technology is, sometimes a person is just too broken. The nurses, techs, housekeepers, and doctors were compassionate, friendly, cheerful, kept us informed and, without pressure, helped us make the decision. I glad we worked as a team to give Dad the best care possible.

Why this long testimony? Maybe I can help you with your choice when a loved reaches the end of their days. Talk with the medical professionals, become informed, . Because we should never treat life casually, not just giving up on people and saying "pull the plug!!!", but neither should we try to cling to them, hurting them in the process. It should never be an easy decision, but it must be made with compassion.

33