Is it me, or is every health care facility I take my elderly parents to secretly intent on killing them off? As a culture, we seem to have moved from death as the ultimate taboo to be avoided at all costs, through a stage of taking it out of the closet and learning to speak openly about the dying process, all the way to the opposite position: “Death? No worries, mate, why keep putting it off? Die now, before it’s too late!”
This past Friday, an Asian female version of Dr. Kevorkian came into my 90-year-old dad's rehab room with grim news. His blood work, she said, had revealed elevated sodium levels, indicating dehydration, and before I could even utter the word "fluids," she launched into her progressive humanist geriatric physician's straight-talking/enlightened-about-death/time-to-let-go-and-say-your-good-byes speech, throwing in for good measure the fact that "death by dehydration is not a bad or painful way to go." I tried changing the subject to "liquids" but she had already moved on to the part about "I know this is a tough time for your family, and we've discussed your dad's Advanced Directive, you've told us he wanted no heroic measures taken to prolong his life" and so forth, and the whole time, I just couldn't help thinking, "How about a glass of water? That's not really all that heroic, really. The guy is just very, very thirsty."
I was a resident hospital chaplain for a time, and was around a lot of dying people and their families. Last year I sat at my favorite uncle's bedside as he took his last breath. I held two of our beloved cats in my arms in recent months as they passed on. My friend and teacher of 34 years died a little over a year ago. I seem to somehow be comfortable with death, and neither my father nor my brother and I believe in taking extreme measures to extend a lousy or certainly a vegetative quality of life. No feeding tubes or intubators. We talked about all of that, and Dad wrote it all down and had it notarized. It's clear.
But I was just thinking that maybe a little bit of moisture couldn't hurt the guy at this point. My mother, nearly 90 as well, seemed to be on the edge of death by dehydration a few years ago, and one IV infusion of saline solution did the trick, brought her back from the precipice, and she is still going strong today, happy and healthy in her own mysterious Alzheimer's world. Her primary care physician advised my Dad to put her on hospice five years ago, so he listened carefully… then fired the doctor!
A few weeks ago, Mom was suddenly vomiting nearly every day, so I casually asked Ms. Kevorkian at the rehab for feedback about it, and having never met my mother and knowing absolutely nothing of her history, medical or otherwise, apart from her age and her condition, she advised me that "It sounds like end-stage Alzheimer's," and suggested we put her on hospice. My wife Shari asked her, “What is it about vomiting that makes you think it is end-stage Alzheimer’s?” She responded with a blank look. So like my father, I listened carefully to her advice, then took Mom to a G-I specialist who examined her and said, "She actually looks quite good!" and prescribed a pediatric dose of liquid Prilosec and told us to take her off her daily baby aspirin, and Mom has been quite well since. My fear, now, is that next time I see the doctor, she will gently advise that it's time for me to go on hospice.
As for my dad’s current situation, we were informed by a neurosurgeon, a neurologist, and a brain-injury specialist that when there is a brain bleed, particularly in a 90-year-old, we shouldn’t expect to get a real sense of to what extent he will "come back" from this “major insult” until the dried blood on his brain has had enough time to get re-absorbed by his body, a process that could take several months, and that further healing can often continue for up to a year. So while the "time to let go" speech wasn't a bad speech—I actually delivered that speech when I was a chaplain—like comedy, it's all a matter of timing. When I gave that speech, I always made sure the family’s loved one was actually dying, and not just very thirsty.
So we ignored her, and took Dad by ambulance to the ER for some IV fluids, where we encountered an attending physician by the name of Dr. McReal. Seriously. And as he was about to put Dad through the traditionally tortuous 9-hour ER routine for admittance, I interjected that we actually only wanted some fluids, and maybe throw in a quick CT scan of his brain if they happened to have a two-for-one Martin Luther King weekend sale on, and McReal's whole countenance changed. His face lit up, and he appeared to be tickled pink that we were taking charge and making our own medical decisions:
"Really? You only want fluids and a CT scan, and then you'll take him back to the rehab? That’s it? TERRIFIC! Coming right up!" He couldn’t do enough for us, we were like a breath of fresh air. (Later we overheard him doing an uncanny impersonation of Gomer Pyle-meets-Mr. Rogers, telling a patient in an adjoining cubicle, "Hi! I'm the doctor! And I'm going to give you some medicine that will make you feel better." Shari speculated that he had escaped from the psychiatric lockdown unit, grabbed a white coat, and was pretending to be a doctor, as in McFake, not McReal. Think about it; he was giving this person medicine. Not a specific medication, just plain, old-fashioned, generic medicine.)
Several hours later, Dad was back in his bed at the rehab, eating and drinking more than he had in several weeks, the color of life back in his face, smiling and then sleeping peacefully. True, It may well be his time tomorrow—or mine—but somehow I just knew that today was not the right time for the "release him into the light" bit. Only yesterday he had been wide-awake and alert, and was messing with this same doctor's head. She had screamed into his ear,
"MAX, DO YOU KNOW WHERE YOU ARE?"
Dr.: "WHERE ARE YOU?"
Dad: "I'm in a quandary."
Dr: "WHO ARE YOU?"
Dad: "I am who I am."
Dr.: "DO YOU KNOW WHO THOSE PEOPLE ARE, STANDING THERE?"
Dad: "That's my son and my dearest old friend."
Dr: "CAN YOU TELL ME THEIR NAMES?"
Dr: "I said, CAN YOU TELL ME THEIR NAMES?"
Dad: "And I said, THE ANSWER TO YOUR QUESTION IS 'YES!'"
And that actually was the accurate response to her question; yes, he could tell her our names; and no, he had no intention of doing so.
Photos of Dad, before and after falling down the stairs and landing on his head:
For all the controversy the real Dr. Kevorkian ignited during his lifetime, all the while, just under the radar, I observed nurses in the hospital performing morphine-assisted euthanasia on a daily basis. Without consulting families, when they decided someone was ready, they just upped the morphine drip ever so slightly. Compassion, expedience, or a little of both?
What would I want for myself, when my time comes? Assuming I don’t get hit by a bus and have the luxury of time and options, I’d prefer a more fun drug. I was hospitalized with a 107-degree fever once, diagnosed as “acute pharyngitis” (translation: “bad sore throat); they gave me morphine and I found that while it was very effective for the pain, it also gave me nightmarish internal hallucinations whenever I closed my eyes. Nobody around me knew what I was experiencing.
Which gives me pause now, when I think about all the morphine-induced hospital deaths I observed. Were those people all floating off in a peaceful, pain-free morphine haze as promised, or were they quietly battling an onslaught of inner demons ushering them over the finish line, while the nurses stood by, assuring their families that they were feeling no pain? Freaked out, perhaps, but feeling no pain.
Although, when I think about it, in my daily life I’m generally freaked out and feeling pain, so in that sense, those dying folks really were one step ahead of the game.
My conclusion after multiple ER visits and hospitalizations with Mom and Dad, is that nobody’s destiny should be left exclusively in the hands of a medical team, especially if you spy a copy of Don’t Sweat the Extremely Important Stuff on their desk, and particularly if each specialist seems to be providing what sounds like directly contradictory information. I mentioned this to my old college friend Billy, a hospital OB/GYN, and he responded,
“Sometimes my colleagues and I draw up a plan and then take turns going in and out of the room telling the patient and the family conflicting information. You should see my 'I can't believe the other doctor told you that' face.”
He was kidding; I think.
Eliezer Sobel is the author, most recently, of Blue Sky, White Clouds: A Book for Memory-Challenged Adults