Nearing the End (of Life)

Nearing the End (of Life)

   It was an interesting visit from my mother and my wife's mother, one being 89 and the other being 85.  Both are in reasonably good physical condition for their ages, mobile and bowels fully functioning as displayed by their enormous appetites, largely for desserts.  And for us, we are fortunate for both mothers are still mentally quite alert, forgetting a few small things and their multitasking skills dropping a bit; but other than a chunk of diminished hearing, they are models of how to live well in their eighties.

   So it was a bit interesting to hear my neighbor, herself a thirty-year vet of nursing studies (from the ER to vascular consults to medical research) matter-of-factly lay out the traditional scenario of what typically happens to people in their mid-to-late eighties.  First, there is at some point a fall, a simple trip on a rug or a garden hose or a buried branch and the weak point that will break is the hip (one always hears that story but statistics seem to back up that result).  We can fix that is what the elderly patient will be told, which will mean anesthesia and for the elderly, waking up after being under and having had surgery makes them feel years older...like ten years older (which would put my mother feeling like she's 99).  The elderly patient would remain intubated due to repressed breathing from the anesthesia and when the physical therapy people would be called, they would likely see that and defer her to ICU to recover more before attempting any sort of rehab.  The prolonged intubation would probably lead to pneumonia, but ICU would reply, we can fix that.  A massive doze of antibiotics would follow, creating a hardship on her kidneys but, you guessed it, we can fix that is what she'd be told (once on antibiotics, the elderly patient would be hard-pressed to be pulled off of them).

   The point that my neighbor was making was that today's medicine picture, that famous end-of-life care for the elderly, is a matter of fixing each problem vs. stepping back and looking at the bigger picture, each section of the hospital almost passing off the elderly patient with life support and getting little input from the patient along the way.  Health care directives (legally binding to the hospital and able to override a distant cousin arriving at the last minute saying stop or continue the life support) are great but need to be updated annually or at least semi-annually.  Newly disabled or totally disabled could be how the elderly patient could emerge from surgery, thus altering his or her ability to function at home.  The issue could be less one of rehabilitation as much as one of being comfortable;  normal breathing might now be as difficult as a return to mobility.  The possibility of calling Hospice now becomes a real one, not only for the patient's comfort but also for that of those suddenly discovering that they are now caregivers, often unexpectedly.

   Preparing for all of this is a reality few of us want to face (although many, including my mother, have).  My neighbor was simply pointing out that wanting to make your own decisions might be best done now, while you can, vs. leaving those decisions up to others (such as relatives) or medical personnel (something as simple as not noticing a DNR --Do Not Resuscitate-- tag might generate a call to 911 which would be obligated to work to keep you alive, perhaps against your conscious or now-unconscious wishes, a scenario that my neighbor witnessed from a newly trained aide).

   Seeing my mother laughing and even enjoying a glass of spiked egg nog over the holidays, giddy at winning several hands of cards (and catching us when we tried to sneak in an extra card or two as a joke), makes both my wife and I realize how fortunate we are.  But the reality is that our mothers are nearing the nine-decade mark and time is moving forward quickly (as my brother-in-law described it, "life grows shorter and shorter, just as one feels when nearing the end of a roll of toilet paper).  My neighbor's advice is good advice for anyone, for something as unexpected as a fall (at any age) or an accident could place any of us in an end-of-life situation.  But that's another day, or so we naturally feel.

   As the holiday festivities also come to an end and a new year is ready to start, this might be a good time to think about what may lie ahead, not only in our loved ones lives, but in our own.  And a good time to get the last of that egg nog, spiked or not.