Elder Orphans

POST:
Sometimes when I wake up, I think I detect a wisp of cigarette smoke that makes me wish I was back in the time when all my dogs were here and curled up around me on the bed and my friends and family were alive to enjoy and make plans with. Today I shake that off and go to turn on the news and make coffee. In the living room is the 48″ TV that my company delivered yesterday as a thank-you for 10 years of employment with them. Now there is a hollowness in the pit of my stomach because it reminds me that my best friend is gone; I can’t call her to tell her that it’s here. She can’t help me set it up like she aways did with new electronics. Now I don’t want it any more, thinking of ways to get rid of it.

I know that grief is selfish, that it’s time to sweep all the memories and self-pity away and move on. Though I’m trying to change my likes and routines and do things differently now that they are all gone, it’s proved to be difficult.
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Maybe coffee will help; or maybe that’s another familiar thing that I should dump. Or maybe someone needs to slap my face and tell me to “snap out of it!”

Any advice? Before you say to get out of the house, attend events, volunteer, meet new people and groups . . . I already do all that. I haven’t found a way to sweep the memories away for good; they keep coming back as though it were yesterday.

RESPONSE
I never cultivated a taste for coffee Carol, but don’t dump the coffee. I would indulge myself at every opportunity! That includes your grief. That same thought occurred to me when my wife died, and I was groping for ways to escape the pain. “Im being selfish” I thought. Mary’s suffering is over, so this pain is nothing more than self pity. To a certain extent that’s true; so what? it’s also perfectly natural; grief is the price we pay for love. There’s no way around it, the only path to the other side is through it.
Seems you’ve been trying to do just that. For how long? No doubt still reeling from Nasa’s excruciating loss. But even though the memories are persistent and bring you pain rather than comfort, they are after all “only thoughts,” and thoughts are not facts. May not feel like it, but you CAN control them. It takes work, and a certain degree of optimism. I know, the optimism is elusive right about now. But aren’t there moments when you’re able to laugh, feel a fleeting surge of energy? If you can’t remember them write them down. Try ruminating on the worth and origin of those feelings for awhile, especially when the sad thoughts creep in. Don’t believe everything you think

POST:
(Regrading Texas bill allowing doctors to issue a DNR, where there is no health directive and it is found, following specified procedures and review, further treatment of a patient would be medically futile).
Texas politicians are not only taking charge of birth; they are now trying to take charge of death. They are debilitating our Do Not Resuscitate, Death with Dignity, hospice, and palliative care programs. The wishes and beliefs of the patient, the family, and the doctor will be altered to suit the dictates of a political party.

RESPONSE:
Regarding the Texas #DNR legislation, Amy made it easy to read both bills, and now informed by the language and presumed spirit of the proposed law I can say unequivocally that two persons looking at the same facts can easily reach two equivocal conclusions. Our world view dictates personal perspective. I personally am not swayed by the “Death Panel” misrepresentation. Nonetheless, the cost savings inherent in reducing medical care at the end of lifer is undeniable, and the Federal impetus for physicians to review palliative options with terminal patients is not based strictly on compassion. Nor can it be presumed that docs and hospitals are anxious to withhold treatment. Most docs will tell you that death is considered the enemy, and prolonging life is considered a win. And a prominent measure of the quality of hospital care is the mortality rate. That is a metric that encourages “heroic” intervention, courtesy of increasingly sophisticated medical technology.

Informed patient choice should be the deciding treatment factor and advanced directives are the most promising tool. Promising but not conclusive. Dr. Karen Wyatt, a prominent voice in the end of life debate, tells of personal experience when she was documented as a DNR without so much as her knowledge, much less permission. She had suffered a bike accident resulting in a concussion and a broken collar bone. During her hospitalization she was asked if she had a living will, and she acknowledged, “Yes.” That was it. Later that day she discovered that a DNR order had been placed in her medical record and posted to her hospital room door, just to make sure. The nurse later explained to Dr Wyatt that since she had a living will, she assumed that meant/implied a DNR order!!??

One of the replies to to the original post suggested she was going to have her DNR/intubation wishes tattooed on her forehead. Even that is not foolproof, for the same reason that a POLST is not a guarantee…lack of context. Let’s assume in the comfort of your armchair and in good health you document that you do NOT want intubation. But would that be your unequivocal decision, lying unconscious on a hospital gurney, if the intubation lasted only 24 hours to get you through a rough patch, and there was a strong likelihood you would make a complete recovery? Dr Jeremy Topin wrote in The Washington Post how and why he disregarded his own father-in-law’s advance directive in an article titled, “I saved an old man’s life. He didn’t want it.” Given the successful outcome, Dr. Topin was confident he had made the right decision, but months after the life saving procedure, fully recovered, his 87 year old in-law said the pain and anxiety wasn’t worth it.

I have a best practice answer for this conundrum, but given the length of this response, I’ll save it for another post!