Terminal

The Health Care "Debate" seems to have devolved into a question of euthanasia thanks to the media's obsession with anything that comes out of Sarah Palin's prolific tongue/pen/keyboard.

OK. Let's talk.

Digby has a good post up about the origin and development of Advance Directives, DNRs and Durable Powers of Attorney in California, and I've had considerable recent experience with the whole panoply of those things (as have many others, it appears, on the blogosphere.) I'm not at all sure where we'd be without them.

Well, no. I can figure how Betty's care and passing might have been different without her advanced directives and my power of attorney over health care issues.

Her last episode began last October when I took her to the clinic where her primary care physician was medical director. She'd been complaining of shortness of breath, chest pains, and she had developed wounds on her lower legs that were not healing. Her doctor was off that day, but Betty was seen by a nurse practitioner and one of the other staff doctors who diagnosed a heart attack in progress, ordered up an ambulance, and took her to the hospital.

She already had an advance directive stating that that no extraordinary efforts should be made to keep her alive if her condition was terminal. She was not considered to be in that state, although her heart was giving out, it was still functioning in afibrillation, and she was able to consent to treatment at the hospital. They determined that the primary cause of difficulty was edema, fluid build up, and they drained her of the excess fluid promptly. She felt much better almost immediately. A heart specialist was consulted, and she was taken for angioplasty and stent insertion. Her decline in the hospital commenced thereupon, not so much because of the angioplasty and stents themselves but due to some botched after-treatment including misplaced injection shunts (that missed the vein causing immense pain and suffering whenever fluids were administered through those shunts) and a very strange (and still inexplicable) determination that Betty could not eat or drink and so was being fed and hydrated through an NG tube.

Then her wounds became infected.

She became depressed and despondent. Her physical condition was not improving, and her psychological condition was deteriorating alarmingly. She wanted to go home, that was really all she thought about or cared about. She wanted out of the hospital, the sooner the better.

Her attending physician, however, wanted her to stay another week, and then go to a skilled nursing facility for three to five more weeks. Then she wanted to put a PEG in her stomach to feed her. Then, maybe, she would be allowed to go home.

Betty verbally agreed to this regimen but she was disconsolate with us about it, and we determined she was going home no matter what, and it practically took an act of congress to get her out of there, but out she came, and home she went.

Ten months later, she died, but she died at home.

She outlived every prediction of her impending doom, and her passing was as close to what she wanted as it was possible for us to provide.

Had she stayed in the hospital and/or gone to skilled nursing for "recovery" I sincerely believe it would have been a death sentence. She would have been dead within a week or even less.

I would call her continued treatment in the hospital or nursing facility a form of euthanasia, in that it was not what she wanted, and her will to live was being sapped there every day.

And if she had not had advance directives, DNRs and durable powers of attorney, quite likely she would have stayed in the hospital and would have died there. I will not, for the moment, go into the ways and means that medical professionals can and do prolong and/or retard patients' survival.

So there's your goddamned Death Panels, and I don't want to hear another stupid word about it.

"Gone from our sight"

Betty passed away peacefully yesterday afternoon. She lived a long and rewarding life, a life of adventure for her, and one of kindness and generosity toward everyone she met.

She had a profound influence on a rippling circle of individuals, most lately of course, the professionals who cared for her as her life waned away, but more inclusively, her family, and the friends who came to visit her in the last few weeks.

As we make "the arrangements", we come to realize that many of those she touched, perhaps all of them who are still alive themselves, have come to visit her and pay their respects for her life and her inspiration. Oh, there have been many tears, to be sure, but there has been far more joy and sense of honor just to know her.

She literally saved my life -- more than once -- and I am eternally grateful to her.

As far as we could tell, she went gently into that "other place" which she had visited before but where she had never been able to stay. We believe that her spirit left her body some time before her body shut down completely, but just when she completed her journey we can't know. She was at peace, though, when the end finally came. The serenity on her face and the easy appearance of her body as she lay in bed while we put up with all the bustling to and fro of the various people who came to certify and to pronounce and to call various others and to pray and to take her body away to the mortuary was a blessing; she was so beautiful through it all.

The friend who called yesterday called again about ten minutes after Betty died. His name appeared on the screen as the phone rang. I answered the phone, "So you know do you?" He said, "I knew yesterday." I told him that Betty had breathed her last just a few minutes before, and here he was calling... He said, "I drove by your house a few minutes ago, but something told me not to stop. I sensed I should go home and call instead." Yes, it was the right thing to do, and we talked for a while, remembering a mutual friend who had been through somewhat the same process of dying several years ago. I said, "You're still welcome to come over. Would it help you to see her one last time?" He said, "I'll be over, but first I'm going to get you all some burgers at the [Burger joint name redacted] and make sure you get some food in you." I thought OMG.

So we went through a whole raft of processes and procedures ending with our waiting with the priest for the nurse who would "pronounce" the death, when my friend arrived knocking on the door, and sure enough he'd brought big sacks of fresh-cooked hamburgers -- which smell wonderful -- and he and the priest, and we and Betty's granddaughter chat about what a wonderful person Betty had been, how much she'd touched our lives, etc, etc, and my friend went over to Betty, who was still very serene on her bed, and he gently took her hand, kissed it and stroked her head and turned away, tears streaming down his cheeks, and just whispered "Thank you." He left not long afterwards, reminding us that we'd better have those hamburgers, and we said we would.

And about an hour later, when all the hub bub was done, we did; we had a wonderful little wake, Betty's granddaughter and us, as we talked about Betty's life, listening to music she liked to hear, and making preps for the next step.

At this point, I don't think there's going to be a funeral as such. Betty's body will be cremated, and her ashes will be split. Her spirit will be honored, and her memory will be secured. I suspect a number of people will write about her -- I couldn't possibly be the only one who does so! Those words will be assembled and distributed to those whose lives she touched so profoundly.

Rest in peace, Betty. You may be gone from our sight, but you will always be in our hearts. It was a privilege just to know you.