After the old man's last stint in the hospital and transitional care I had to take him to his primary care physician. This is Dr. Stockman at the Center for Senior Services. He is a gerontologist, someone who specializes in the very elderly. (As an aside to medical students, go into gerontology, huge shortage and aging population.) Dr. Stockman looked at the orders from the nursing office at the assisted living apartments where my parents live. He said to me, "Why does it say to resuscitate?"
"Sidney, it says here you want to be resuscitated if your heart stops or you stop breathing" he said.
"Damn right" said my father.
"I don't think that is the right decision. You are much too frail to survive it."
"Well I want them to try. I don't want them to bury me the minute I stop breathing."
"There is a 99% chance of failure," the doctor explained.
"So, I will be the 1%!"
"If by some miracle you do survive, you would be in terrible pain. Your ribs would probably break and you would never walk again."
"That's OK, I will take my chance," the old man insisted.
"Sidney, I would not sign the order to resuscitate you at almost 94 years old and in your condition."
"Dad," I said, "you would not be able to move and you would get weaker and weaker and have no quality of life."
"OK." he finally agreed.
Several days later he told me that they came to him at his apartment to sign the revised orders and he refused. He wants to be kept alive by whatever means. Which brings us to yesterday.
I went to pick up the old man and the old lady. The plans for the day were to go to a record store where they could pick out some music. Then we were going to Chez Daniel for lamb chops. The old man told me he was feeling weak. The old lady said he asked her to call me the night before. "So why didn't you call me?" I asked. She wanted to see how he was in the morning after he slept all night. Again I had to tell her that this was the reason I moved them from NY. Last time she wanted to call 911 and he told her not to. He wound up staying three days in the hospital and three weeks in transitional care that time. Call me, I emphasized. If he says to call me, then call me.
After we were in the car the old man tells me the aide told him his blood pressure was high. "How high?" I asked. They didn't know the numbers, but high. I immediately drove to the fire station and had them check his bp, 180 over 80. That was pretty high and he was weak and almost dizzy. I didn't bother with Urgent Care and brought him to the ER at Methodist Hospital where they did triage and put him in a cubicle. They did some tests and don't know what the problem is. He is established in a room for observation and more tests. Every doctor who came in asked what the problem is and every time he says he can't eat. His taste buds are shot and he chews but does not seem to swallow. He has been living on Boost which he drinks through a straw.
The admitting doctor and the old man had the resuscitate talk. He told her he wants to be kept alive on machines. They are to do everything possible to keep him alive. I followed her after she left the room and we had a little talk. I said not to resuscitate. She said she saw the notes from Dr. Stockman. I told her my dad had some dementia. She said she understood.
Here we get to the ethics of the situation. Is it right for the medical team and myself to make the decision to let the old man die when he absolutely wants heroic effort made to keep him alive? Is it right to put him through extreme pain in that pursuit? Is it right to ask the taxpayer to foot the expenses of keeping him alive on machines? At his age and in his condition it would be for a short time. He doesn't have the physical resources to last long.
The heart of the matter is that my father is quite frightened of dying and thinks any kind of crappy life is better than death. Both he and Harriet believe you live and you die, and that is it. They don't believe in any kind of Creator, but the old lady is ready to go. She insists that no one keep her alive on machines. She might get a little confused as to times and days, but even half deaf and legally blind she essentially has her marbles.
I believe there is an energy that keeps us alive. That is the difference between a live body and a corpse. Call it soul, or God, or whatever word you want. I call it energy. If energy cannot be created or destroyed, then it came from somewhere to animate my human life and when it leaves my body it will go somewhere too. It will either merge with universal consciousness, or go back in line for another go round, or something I have no idea of and will not know until I die. I do know I am not scared of dying. Whether I am scared of living is a different topic for a different day.
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