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Archive for the ‘elderly’ Category


My column from last Sunday’s paper…

A living will is one of those documents you don’t usually think about until circumstances force you to, and then its piercing questions cut straight to the meaning of life.

How hard, and at what price, do you want the medical system to work to keep you alive? Therefore, what does it mean to be alive? This is not light Sunday morning reading, to be sure. For me, the living will took most of a Sunday afternoon to labor through on behalf of my elderly father, whose health just took a turn for the worse.

The first question asked whether he wanted CPR to be administered. He’s always said that if there’s a breath, there’s hope, so I guessed he’d say yes. But now I read that risks of CPR, particularly in the elderly, include broken ribs — one of which could puncture his lung and require mechanical intervention and a chest tube. He could also suffer brain damage because of less oxygen to the brain, and vomiting that might cause pneumonia if it aspirates into his lungs. Really? Call me naive but I had no idea, and, as it turns out, neither did he. In other words, he could be sicker than when he started.

Of course, the alternative is death. So there lies the question: How alive is alive?

Many physicians spend their days saving lives yet would not want heroic intervention for themselves; they well understand that it’s often futile and, worse, imposes suffering on the patient. Dr. Ken Murray writes about quality of life vs. its length in his poignant blog called “How Doctors Die.” (http://bit.ly/LP2d7g)

So many people wind down their lives in an ICU attached to tubes because traumatized family members tell doctors to do everything possible. They’re expecting a chance for the patient to resume a normal life again. Often that doesn’t happen; the patient may live, but not the life they knew. Family doesn’t realize, nor are they usually told, what’s reasonable to expect. And in the process, tens of thousands of dollars are spent every day.

As a hospice volunteer, I witness the process of dying each week. Patients experience their final days receiving compassionate care that minimizes pain and offers emotional, social and spiritual support. It’s usually not death that people fear, but rather pain and social isolation. Facing the end, people realize that it’s relationships that matter and spending time with loved ones takes priority. A book by Dr. Ira Byock summarizes four things he found matter most to a dying person: “Please forgive me. I forgive you. Thank you. I love you.”

Author and philosopher Joseph Campbell says that the real search isn’t for the meaning of life so much as for the experience of being alive. Nobody wants to end their days wishing I had, or hadn’t — we all want to live significantly and feel we’re making contributions of some kind to the planet and each other. We want our lives to have meaning until our last breath.

One of my favorite reads is by Rodney Smith, whose book “Lessons From the Dying” is, despite the title, more about living. During his hospice career Smith gleaned insights about what’s important in life. There are gems throughout this work, but his summary point might be, “It helps to live with the end in sight.” Each day matters, and living it consciously is a choice we’re all empowered to make.

Everyone is going to die. The question is how do we want to live and at what cost?

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We say yes, he insists no.  What’s a child to do?

Right now my 89 year old father is in a rehab unit hoping to re-gain the strength of his body.  His legs don’t work that well anymore, particularly his left leg that’s grown weaker in the 20 years following his stroke.  The same is true of his arms; the right does the lion’s share of work while the left hangs limp at his side.  He desperately wants to return home where he was about a month ago before this current crisis took place.  There he was able to move ever so slowly using his walker and also to perform the daily rituals of living.  Now he can’t get in or out of bed by himself, bathing and dressing himself is impossible and he requires the help of an aid to move even more slowly and unsteadily in his walker for yet shorter distances than before.  And yet he’s convinced himself that he’ll get strong enough to go home and continue life as before.  It doesn’t look promising, though he is improving.

The food there is good; we’ve tasted a bit of all his meals as they’re delivered.  He’s receiving excellent care, has a private room and is in a very cheerful, bright community of people with a similar cultural background as his.  He’s been accepted into their long term care household which is where we want him to live.  He refuses, complaining about the regimented lifestyle and business-like attitude of some of the nurses and aids.  They have schedules to adhere to regardless of whether he agrees.  He likens it to life in the military some 70 years ago and says he wouldn’t wish it on his worst enemy.

We’re in a stalemate.  Once his physical therapy is finished we’ll have to make a decision.  What do we use as our guide?  Our judgement, as his children, about what’s best for him?  Or his emotional insistence on the way he wants to live out the rest of his life?

Based on history, we think that if he goes home he’ll “fire” the aids after a short period of time because he thinks they’re no longer necessary.  It’s happened before.  He hates spending the money; he considers it wasteful.  He wants to die with his money intact “just in case.”  “Just in case” what?  we probe.  “I don’t know” is the answer.  He can’t grasp the idea that NOW is the” just in case” he’s been saving for.

Life at home consists of sitting solitary in a room and watching TV all day.  His only company is my sister when she returns from work and my other sister when she visits.  On many Thursdays he hobbles to his car and drives to meet his buddies for lunch at the nearby deli.  He shouldn’t, but he does.  I doubt he’ll be cleared by a doctor to continue driving.  He’s convinced we’re wrong.  He must keep his car.

When I was a kid I went to hebrew school and took piano lessons because my parents insisted they were beneficial.  I disagreed.  It didn’t matter.  I went and I practiced — for years.  And years.  And years.  Now, as an adult, I’m a richer person for the experiences.

He doesn’t see the analogy.  He sees himself as the parent who knows best.  We disagree.  Who wins?  And at what cost?

What do you say?  What would you do?

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Growing Old


Health

Health (Photo credit: 401K 2012)

It’s a bitch to get old and feeble.  None of us thinks about it while we’re busy with our lives managing careers, family, friends and the daily mundane chores of living.  Nobody anticipates the day when we can no longer take care of ourselves, relegating decisions about our life to others.

That rude awakening landed square between my eyes while now playing the role of parent to my elderly father.  He’s always been a ferociously independent, active man who supported a family of six, sent his kids to college and provided the religious education he considered to be important.  He ran a business and answered to himself about all matters.

As a renegade, my father felt rules were guidelines that he could follow or not.  He could run red lights if he determined there to be no traffic, but God forbid any of his kids do that if he’s a passenger in our cars.  If his customers were tardy on paying him, his bills could wait until cash flow improved.  Any imposed penalty for lateness didn’t apply to him because of his extenuating circumstances.

Now he sits in a wheel chair while his body defies his craving to walk and go and do.  Now he has to listen to us.  And his therapists.  And his doctors.  And eat food they want him to eat and drink liquids that are unappetizing.

Life is incredibly difficult for him these days and at 89 it’s damn near impossible to become a different man, a deferential man.

My heart aches for him and I wonder whether he will be me someday.

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