Posted by Rich Conley on July 20th, 2007
It use to be said that pneumona was an old man’s friend when it came to dying. This was because pneumonia was relatively quick and painless. Today it is a different story.
Medical technology can wring the last drop of life out of the human body. I know because I’ve watched my 87-year-old father with tubes shoved into every orifice, his blood filtered, arterial punctures, sedation, x-rays and blood drawn daily. The intubation tube causes a continuous gag reflex and scars the larynx.
The frustration of an old man with failing hearing and eyesight with a tube down his throat is that he cannot not talk and express his last wishes.
We thought that having an Advance Health Care Directive with power of attorney would prevent this sort of thing. Little did we know that the restrictions on communication with our dad would prevent us from knowing his wishes. What we found was that his hearing aids were removed (body temperature is taken from the ear now) and his glasses were removed (tubes over the ear and through the nose prevent glasses) and a tube down his throat prevents speech.
We’ve watched our dad age. . .no catastrophic illnesses. . .just slow gradual deterioration. He was fully cognizant of his condition and had no wish to resist. Vision almost gone, hearing still barely working (he hasn’t heard a bird sing in over thirty years) both hips replaced and worn out again, most of his friends and workmates passed away, wife passed away and kids grown and in pursuit of their own lives - for our dad life was good but worn and faded at the end.
All of our life stories have the same ending. The way the ending is written is important though. For my dad it was a good life. He lived at home and took care of himself until the last few weeks.
Pneumonia was his last illness. . .we got him to the hospital and the next day they moved him to the intensive care unit. He needed intubation to continue breathing. When I arrived he was fully cognizant but sedated. When I said “Hi Dad!” he opened his eyes and looked at me.
Then, with distinct movement of his eyes and head, he looked to the left at the stand of plasma bags and meds, then a sharp glance at the tubes at the head of the bed, then a another distinct glance at the breathing machine on the right.
Finally, a last look directly into my eyes with a slight raise of his eyebrows.
I know immediately what he was telling me. “Get this stuff off me.” His hands were restrained because he had already tried to remove the breathing tube. I felt like the bad son because I knew his wishes and I could not carry them out.
The Advanced Health Care Directive said that that family and doctors should discontinue life support if efforts were deemed futile after three months. It was a standard Health Care Directive and no specific provisions were made for specific wishes and possibilities.
And so we watched as doctors fought to overcome each biological technicality over a course of ten days. By the tenth day dad’s left eye was fully dilated and did not constrict. His mouth sagged and never closed. He stared straight ahead and was barely responsive. “Hi Dad!” produced no results.
The doctor said that one more kidney dialysis treatment would bring kidney function back, or closer to normal. They seemed to ignore the obvious neurological problem that occurred. It was if the medical team was intent on winning individual battles while the war engulfed them.
The worn old man, even though cured of the pneumonia, could not withstand ten days of assault by modern medicine. His biology crashed and on the tenth day he was free of the plastic snakes and needle sharp fangs.
Dad’s release was a relief for him. But for me, I will forever carry the feeling of letting him down at the last. Even though we thought we were prepared, we were not. In this instance, the Advanced Health Care Directive was of no value.
It is, however, a lesson to study. Advanced Health Care Directives have provisions where one can give very specific directives. Perhaps specifying one’s age and treatment options, one’s remaining capabilities, neurological capacity and other remaining functions the directive can give doctors milestones by which to determine when to quit the battle.
Knowing what I know now, I will do things differently for myself. We all get a turn at this event. Hopefully, I will approach it with grace and calm.
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