medical interventions in dying – Page 2

Helpers fail, comforts flee

I enjoyed this piece by David Nobbs, creator of Reginald Perrin, in yesterday’s Observer. Here are some extracts.

My mother died on 7 August 1995. I didn’t realise, that day, my life had changed … My mother died, as she had lived, unselfishly. After she’d died, my wife Susan and I were just in time for Sunday lunch at my aunt’s. That may sound frivolous, but it was so typical of her I actually believe that some unconscious influence was at work.

She had lived about as happily as it was possible to live in the 20th century, for almost 95 years. She had been ill and in hospital only for the last two weeks. At times, during those two weeks, she had been restless and disturbed, but that Sunday morning she became more and more peaceful. Her breathing began to get slower. She had worried for Wales, and I had no doubt this contributed heavily to her worry lines, but now all those lines disappeared – her face became smooth and she looked young again. Her breathing faded and slowed so imperceptibly it was hard to recognise the moment she actually died.

I can honestly say, on reflection, that witnessing her death took away from me all fear of my death. (Not of my wife’s death. I fear loss dreadfully.)

That doesn’t mean I welcome the ravages of old age. I fight against them. In my 70s I have taken on a fitness trainer and last month I began to tweet! I hope that I will not die in great pain or in an old people’s home. But I no longer fear the moment when I will cease to exist

But the most important thing that happened to me in the wake of my mother’s death wasn’t the strengthening of my feelings against religion. It was the strengthening of my feelings for disbelief. I believe that there are just as many of the “Christian virtues” to be found among the faithless as the faithful…

Loss of faith. It sounds so negative. I didn’t lose faith. I gained faith. Faith in people. I am proud to describe myself as a humanist.

This growing conviction has had quite an effect on my writing – on the novels, at least. I am sometimes described as a comic novelist, but I describe myself simply as a novelist. I write about life, and in life I see much humour and much tragedy, and that is what I write about.

An irony of all this is that if my mother could hear me, could read this, she would be very distressed and would be horrified to think that her death had led me down this road. Well, there it is, it’s what has happened and luckily I believe (know?) that she can’t.

Read the entire article here.

David Nobbs talks about how he is dealing with ‘the ravages of old age.’ I guess that, as we embark on an era when, for most of us, we’ve never had it so old, there will be more and more writers dealing with if and how ageing can be made endurable as physical debility advances and we are deserted by all interest in sex and shopping. A book which has been well reviewed is Jane Miller’s Crazy Age: Thoughts on Being Old. There’s article by her in the Guardian here. The social problems thrown up by an ageing population will become more and more apparent in the next 20 years and I suppose the answers to them are, for the time being, unthinkable. But not for very much longer.

Over on BBC Radio 4 tonight at 8pm there’s a challenging-sounding if uncheerful-sounding programme, Exit Strategy, by Jenny Cuffe about assisted dying and self-deliverance. “The debate over whether we should legalise assisted suicide is not going away. But whilst we flounder over the grey areas of the British legal system, a radical Australian doctor has found a loophole. Because physically helping someone to die is illegal, he is providing information to paying participants on how to die peacefully and painlessly kill themselves … Talking with geriatricians, psychologists, campaigners and elderly people she explores society’s last great taboo: death. She asks why so many people approaching old age are scared of dying. Are they being failed by our care system? Are advances in medicine extending quantity but not quality of life? Or is even discussing assisted suicide for the elderly symptomatic of an ageist society that undervalues the old? Should the ‘I want’ generation be able to make the choice of when we die and have the right to plan our own Exit Strategy?” If you miss it, you can always catch it on the Listen Again.

Cruel and all too usual

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.