Two completely different views of reality.
Behind door number #1
88 years old white male. PEA (pulseless electrical activity) cardiac arrest with associated anoxic encephalopathy. This is when your brain lacks oxygen long enough to turn you into an unresponsive but not brain dead state.
What's our plan with him as directed by his wife and POA?
Trach and feeding tube. Weeks out from the event, her expectation, despite hours of discussion to the contrary is that pappy will make it home.
Pappy ain't making it home.
EVER.
It's unfortunate that she she has just created a life of unabated misery for her husband until the inevitably churning grips death take hold.
Behind door number 2:
We have a 75 year old Hispanic female who has colon cancer and a horrendous 6 months of in and out of hospitals due to complications of her surgical resection. She has 6 children and 49 grand children.
49 grand children. Amazing.
We had a wonderful talk today. She sat all her children down one day in the past and told them all point blank:
"We were all born to die"
She told them all under no circumstance will they ever approve a breathing machine and life support for her. A highly religious person, when her time has come, she wants to go.
A surgeon once told her she should sue another hospital for poor management of her post operative complications that he felt was due to inadequate care.
She said she could never sue anyone. She went on to site Bible versus about forgiving.
An amazing woman. 6 children. All of them have become contributors to society.
So what's the difference between these two families.
What makes one families view of reality so far skewed with unmanaged expectations, and the other one right?
4 Outbursts:
I'll always remeber how my grandmother died - on the night she had a massive stroke at age 85, she lay in her hospital bed with nothing other than an IV and some nasal prongs, surrounded by every one of her children and most of her grandchildren, all of whom kept vigil and took turns holding her hand. There was never a question of doing anything more than seeing her off after a wonderful life.
I am forever grateful to her doctors, old time family physicians who knew their patient after having taken care of her for years, and who knew what she would have wanted.
Her 48 grandchildren will use up just as much, if not more, resources as pappy on the breathing tube who ain't coming home.
All the support the 88y/o had is a wife? Who is probably also that old? That would be a hard decision.
A woman with 49(!) grandchildren has probably lived a good life and seen many relatives sicken and die. Most likely she doesn't want to end up like some of them did.
I often wonder if those who've lived well are less likely to cling to a sub-standard life in the end.
While the 49 grandchildren may consume away, hopefully they've made some contributions as well.
When my great-grandmother had her life-ending stroke (I was born in her lifetime but have no conscious memory of her) the family was clear on what to do: Let her go. Her dark hair had turned gray overnight,* and she was doing nothing but muttering over and over again, "Hospodi pomiluj" (Lord have mercy). She was otherwise unresponsive.
My grandfather, after his massive stroke, required in-home nursing but not ongoing life support. He had a DNR in place anyway. Everyone knew that clinging to life past a certain point is useless. As it happened it was superfluous; he died peacefully in his sleep at home.
My nearly 12 year old son has severe cerebral palsy resulting from a grade IV intracranial hemorrhage when he was two days old, with subsequent hydrocephalus. The bleed happened simultaneously in numerous organs. He was a preemie, and I suspect part of the cause was that his gestational age was determined to have been 26 weeks based on his weight (770 gm). We thought, based on when we believed him to have been conceived, that he was at 23 weeks. The treatment he was receiving for low blood pressure may therefore have been inappropriate.
We didn't sue. At the age we believed him to be, chances of his survival were minimal at best anyway, and decisions had to be made with the best information available. Both my wife and I were satisfied that the best possible care had been provided, and it's idiotic to ask for more than that.
Why do people nowadays so often ask for more? I suspect a pathological fear of death leads to expectation of the best possible outcome every time. I think the logic is something like, "I fear this. It must not happen to me. It can't happen to me. If it does, it's someone's fault. That someone must pay."
It's a mistake to shield children (or ourselves!) from death, with things like closed-casket funerals even when the body isn't mutilated. My mother's family did this; my father's family I mentioned above did not. In my church there is even an ancient tradition of kissing the body before it's taken out for burial. That kind of familiarity leads, perhaps not to comfort, but to acceptance, and to realistic expectations. They are desperately needed.
Sorry that's so long.
*I know this is physiologically impossible, but my father swears it happened, and that she never dyed her hair.
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