Monday, December 07, 2009

Letting go.

I've ranted about this topic before. After events of a week or two ago I might, possibly, be coming to change my view. A little.

Bill was 97. He'd been living in a nursing home for the best part of a decade. It was a nice home, well run, and he was cared for in every sense of the word. To start with he was just a bit older than the average resident, but down the years as faces came and went he gradually became the eldest.

When he went in he was just a bit wobbly on his legs, and a trifle vague on times and dates. Over the time his wobbliness had become worse, but his haziness lifted (largely because his previously unfettered access to sherry was rather more "managed"). Slowly he took to spending more and more of his days in the chair, but remained bright, alert and sociable.

Last year his ticker started playing up, odd missed beats now and again, then runs of palpitations, then the syncopated jazz riffs of atrial fibrillation. This tipped him over the edge and into heart failure-- an increasingly debilitating shortness of breath with attendant ankle swelling-- which he grew to hate, and perhaps to fear. We tried him with digoxin, diuretics and one or two other things with little benefit. In the end his heart just wasn't up for being pushed any harder, and he began to fade.

And so it was that with a heavy heart a few weeks ago I was called in to sit down with him and his family to ask the awful question, "if your heart stops what would you want us to do about that?" The home needed to know, partly because it's good practice these days, but mostly to make sure they could respect his wishes. In the event that we hadn't asked the standard assumption is that resuscitation will be attempted and paramedics will be called. Bill, quite rightly, didn't want any of this for him. As he put it "I had my three-score and ten some time ago and everything else has been interest."

Within a few days of our discussion Bill passed peacefully away with a daughter in attendance. It was almost as though he'd been looking for permission to let go.


Anonymous said...

Dear Doctor Jest,

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I’m contacting you because I found your site in a prominent health reform blog search and want to tell you about my newest blogging platform —the public concern of health care and its reform. Our shared concerns include health reform, tort reform, public health, safe workplaces, and asbestos contamination.

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Barbara O’ Brien

Doctor Jest said...

Anon (Barbara)-- Sorry Barbara, but I'll have to decline. This blog is polemic only when I chose it to be. It seeks no endorsement and offers none. It's just where I come to let off steam and start to compose some kind of memoir.

In all honesty it's not nearly important enough to merit your attention, and I'm quite content to keep it that way.

Best wishes,

Dr J

Anonymous said...

your last sentence says it all so eloquently..."permission to let go". thanks for your willingness to sit with him and family to have this conversation - so often in the states we make these decisions hastily, as if ashamed to talk about death. thanks for being who you are, and for being willing to share your experiences in such great writing.

Doctor Jest said...

Anon-- You're too kind, but I am genuinely touched. Thank you for your kind words.