Life Can Change On a Dime…

 

pompanobeach-20121209-00039I am in the air again, flying to see my mother.

But this time, it’s because she is in the ICU.

My brother called me Sunday night and told me that she was admitted to the hospital because of breathing problems. She had another heart attack, developed pneumonia, and is now on a ventilator. My brother is already there, waiting for me.

One week earlier, our entire extended family was in Florida spending a week at a beach house. My mother sat on the beach, watching her three great grandchildren play in the sand; her adult grandchildren care for them, and her children soaking up the Florida sun. She was in the bosom of her family, absorbing our love and attention. She was in bliss.

But now she is on a hospital bed, with a breathing tube in her lungs, holding on to life. It’s true. Everything can change on a dime. We are wondering if she is coming to the natural end of her life. Or will she squeeze out a few more drops of time? At 91 years of age, it’s anyone’s guess.

My mother has prepared us well for this moment. She has made it very clear what decisions we should make in such a situation. My oldest brother is her “Health Care Proxy”—she has deputized him to make health care decisions for her if she is unable to. This is now the case.

Fortunately, my brother and I work well together. We had a similar experience when our Dad came to the end of his life. We both understand and respect our mother’s wishes. She is a very old woman who has lived a full life. She is not afraid of dying. While we don’t want to lose her, we recognize the inevitability of life’s end. We are not afraid to follow her wishes.

She only wants life sustaining care (ventilator, feeding tube, etc.) if it will return her to a reasonable quality of life. But what does that mean? In practice, in real time, these kinds of decisions are often difficult to make. What should we do, if after she is weaned from the ventilator, she goes into respiratory distress? Do we allow the doctors to put her back on life support? Or do we let her go?

What if her heart stops? Do we allow the doctors to resuscitate her? Or does my brother sign a “Do Not Resuscitate” (DNR) order? These are the practical decisions that family members must make.

We both know that every hour on the ventilator will weaken her ability to breathe on her own. We are fortunate too. My brother’s daughter is an emergency room physician and communicates directly with my mom’s physicians. My close friend is a retired ICU doctor who knows this landscape intimately. He is able to tell us what may transpire.

The clock is ticking.

It’s very important for families to discuss these matters with each other. I recently designated my youngest daughter as my “Health Care Proxy.” In addition to completing the form, I talked with her about my wishes and discussed a variety of scenarios. We had an open and frank discussion about my beliefs about end of life care and what I want. I have total confidence that whatever happens, she will make sound decisions. And, I know that she and her sister, like my brother and I, will work together well.

Check out the National Institute’s of Aging website on end of life planning. It can help you navigate some of these challenging issues.

Don’t put it off. Remember, life can change on a dime.

Share some of your family’s end of life experiences. What went well? What would you have liked to be different?

8 Comments

  1. Mari

    I’m sorry for this hard time, Paul. Thank you for sharing and prompting us to not wait.

  2. Nora John

    Dr, Schoenfeld, thank you for this valuable post during such a stressful time for you and your family. My 88 year old Mom’s health has been like riding a wave. This time last year I thought she would not live to see Summer. But she did. She is really winding down but her family never knows if she will rally again or not when she catches a virus or takes a fall. Like your Mother she is a lover of family and life. She lost her hearing several years ago and the tragedy is that she can no longer hear music which has been her passion. She can read lips like nobody’s business, lucky for us all. Mom lovingly worked with my siblings and I over the years to simplify our lives upon the event of her passing starting with a major downsizing of her possessions, appointing me Durable Power of Attorney and for making health decisions, putting my name on her checking account, and filling out and signing a Do Not Resuscitate order with additional wishes conveyed to our family. Her example led me to get my affairs in order in similar fashion years ago. That Mom is trying to save her family from as little decision-making as possible in a time of great emotional duress is the most loving action a person can take. I am keeping you, your family and your beloved Mother in my thoughts today and beyond.

  3. Cindy

    Thank you for this post. Such a great reminder to care about these details so that family does not have to figure it out. We recently had this happen, and each family member had to process what they “thought” Grandma really wanted. It caused many ill feelings amongst some family members. In the end, she is gone and I know that she would not have wanted the family to have such distress. I wish that she had completed the papers that were ironically sitting on her desk.

  4. JPG

    Thinking about you and your family Dr. Paul, and wishing you peace during thise stressful time. My family recently went through this with my grandmother. Like your mom, she had planned ahead and everyone knew what she wanted, which made the difficult time more managable.

  5. Robin

    My thoughts and prayers are with you and your family during this difficult time. I lost my 91 year old father two years ago so I feel your pain and my heart goes out to all of you. Take care.

  6. Lanna

    Dr Paul ,My thoughts and prayers to your family. It is hard to see our parents age. Thank you for reminding us to make sure everything is in order.

  7. Susan S

    So glad you had that wonderful time with your mom, regardless of what happens now. I will be thinking about you and your family, and taking the lesson to savor those really great times.

  8. Anonymous

    Dr. Paul, my thoughts and prayers are with you and your family. My parents died in 1987 and 1992. In the last six years of his life my father had five major surgeries and there was a time when he ended up in ICU and the doctor asked us (the three children) what kind of life sustaining measures he should take. Because of prior conversations, we all knew that DNR was the appropriate response. Fortunately, he did recover that time. During those last five years, my siblings and I were doing everything we could to support Dad and each other. My pastor later said to me that he envied the loyalty my siblings and I had because he knew that he would never have that with his brother. The one other thing that happened for me during the trying post operative times was that many people asked how my dad was doing–their concern was wonderful. But, the one person whose response I cherish most was the friend who always also asked me how I was doing. In the end, my dad helped us all by maintaining his incredible sense of humor through the whole process. The end of life is an emotionally difficult time, but we all have the opportunity to support each other in ways that may seem insignificant to us, but mean the world to those we are supporting.