Cruel and all too usual

Charles No Comments

There’s a good, long piece in the Huffington Post by Lloyd I Sederer, a doctor, describing his mother’s decline and death. He describes a problem which is going to become more and more common.

Longevity is not all it’s cracked up to be. If we are lucky enough live into ripe old age, our dying may well be a protracted and unbearable ordeal prolonged beyond humanity and reason by attentive medics. That’s why more and more people are going to Switzerland to swallow hemlock.

It’s something society needs to address with some urgency. The problem is already big and it’s going to get huge.

Here are some extracts from the Huffington piece. I’m sure they’ll impel you to read the whole thing.

My mother died on a Monday a few weeks ago. We buried her, in the Jewish tradition, the next day. But we lost her more than a year before when a cardiac event she survived robbed her brain of the oxygen that sustains it and ushered in a dementia that took her away well in advance of her death.

The mental torment of dementia is what gives it its unique cruelty. As horrific as the psychic pain of dementia is, I wonder if it gets the recognition it warrants. Medical care has come to appreciate the crucial importance of mitigating physical pain but mental pain, no less agonizing, has yet to receive its proper due. Psychic pain is equally distressing as physical pain, and to make things worse, for dementia it has few good remedies.

I know death was a relief for my mother — a desired end … She also had made her wishes perfectly clear years before in her health care proxy and power of attorney. She understood, though never used the term, what dying with dignity meant.

…decisions abound during the process of first declining then dying. Not to mention the often tortuous decisions about money, there are decisions about treatments: how should someone be treated for their illness as well as the cascade of complications that frequently befall someone as their immunity diminishes and their infirmity increases. There are decisions about care taking … the most well known decision is whether to DNR (Do Not Resuscitate), but the questions are far more nuanced, as a rule. Here is where a living will or health care proxy is a blessing.

My mother’s time was ushered in after she fractured her hip trying to climb out of bed during a night of terror we could only infer was from her distress. But here is a story about American medicine that needs to be told.

The fracture was discovered some days after it occurred when she was rushed to the hospital with trouble breathing. I received a call from the physician’s assistant to the chief of orthopedic surgery. My mom had a hip fracture but the bone had not been displaced from its socket … She was in no pain. The PA said they wanted to operate, to place a set of screws in her hip … I called back to say no and soon received a call from the surgeon himself to urge me to proceed with the surgery.

That moment was a wake up call for our family. We asked ourselves what would give mom the best moments of life and experience in the time she had left? We realized that goal would be best achieved if we placed her in hospice care. This may sound oxymoronic, but when the time comes give it a try. Fundamental to hospice, contrary to common understanding, is how to make the most out of what time remains, not how to deny care or bring life to a rapid conclusion.

Fighting death and disability at the end too often steals what few moments of actual life remain for someone facing imminent passing. For my family, it was human kindness and eschewing aggressive and dubious treatments that enabled our mother to savor at least a few good moments while still on this earth. But thankful as I am for that I still wonder, until we have more miracles in medical care, is there a better way than the path we are so stubbornly now on?

Find the entire article here.


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