Its taken me a long time to write this second post. I wasn't sure it was even worth the time. But something changed this morning after reading an Op-ed piece in the New York times. The piece linked to another essay about a man dying of ALS. That man had already decided not to take advantage of all medicine had to offer. And that's the primary reason for this blog.
How do we advance our beliefs, mores and feelings at the rapid rate of medical advancement? I dare to say we humans have fallen behind our own science.
In Lewis's case, he was 72 years old and still driving his granddaughters to school. One day he fell. Then he seemed to be falling more often in the next couple weeks.
His congestive heart failure kept him on a strict fluids intake diet along with a myriad number of other "directives": Low sodium, low cholesterol, and low fluid, (yogurt and pudding are fluids). That doesn't leave much if you think about it and is almost impossible for a 72 year old deaf person living alone to comply with.
The fluid was the most important. He was to monitor himself by weight. If he gained a couple quick pounds it meant he was retaining fluids. A more visible sign was that his lower legs would swell. He was supposed to "just go to the emergency room" if he began to retain too much fluid.
He didn't like the emergency room wait and sitting there with all those sick people. His choice was to stay home in front of the TV and swell, or get up and go. Understandably, he would always wait until he was as sick as he could stand before agreeing to go in.
He would be bloated, his heart working too hard, short of breath, nauseous, and delirious at times. But these episodes, as we called them, required a few days in the hospital where they would drain off the fluids, shake their finger at him, as would his family, get him back to reasonable health and then send him home for more "recovery". Sometimes this would include the use of daily nurse visits for meds supervision and therapy.
As Lewis felt better he would skip the nurse visits as he would be back out driving, shopping, etc. To his credit he never just holed up. He wanted out and would go at the first chance.
The finger shaking I mentioned earlier was about trying to convince Lewis that more frequent visits before he got so sick was better than infrequent visits that were debilitating. They also included stern advice on food and fluids. Lewis was always thirsty and pushing the amount of fluids he took in.
It seemed that he could just go in for a tune up and come out fine.
Sunday, July 17, 2011
Sunday, June 5, 2011
Why write about death?
My father-in-law just passed at age 72. He was a kind and loving man and meant a lot to our family. I am not writing a memorial however, it's more of consolidation of my experiences about one person's road to death. I am compelled to write because of the experiences we had with Lewis over the years in the US healthcare system.
Lewis had heart issues from an early age. His first bypass surgery occurred in his early 40s. His second in his 50s and he endured a life of blocked arteries and poor circulation. He worked at the US Postal Service and enjoyed the benefits of an early retirement (age 62) and good health insurance.
You can imagine all the details of a life with a weak heart and I don't really have any great insight into those years. I just know that today's medicine, surgery and healthcare can manage just about anything. We predicted Lewis's demise many times, knowing that he had suffered heart attacks, surgeries, stents, carotid surgeries, the insertion of a pacemaker and then a defibrillator.
It turns out it's just hard to die in America, we know how to prolong life in so many ways, but, it always seemed a kind of miracle when he would bounce back from the latest insult. It was hard not to asses his latest trip to the hospital as possibly his last but he would always come through with an ability to continue to lead a productive retirement life.
That brings me to one of the reasons for writing, the challenges of today's modern medical science. How do loved ones asses the diagnosis and prognosis? How do you plan for someone's future when they and medical science conspire to keep going, forever? When they are at pill number 10. 11, or 12 does that mean their time is near? Surgery number 10? Hospital stay number 10, or even 20?
When Lewis retired he also got divorced. I worked on his divorce to help them divide their assets painlessly and fairly. But in that effort there came decisions that would be effected by Lewis's longevity. How do you predict that? You don't. But you do have to make some judgements to properly divide things like retirement benefits etc. A lump some payment is worth more if you only live a few years while an annuity, paid monthly, is worth more if you live a long time.
I can say now, with the clarity of hindsight, I made the wrong judgement. His ex-wife received the far greater benefit because Lewis lived longer than anyone imagined. After three more years his lump sum distribution became worth less that her annuity. He then lived another seven.
That's just one of the many life decisions that are affected by a loved one's longevity. But there is a lot more to the story. When the end time seems near there are a flurry of these kinds of decisions, and, some more than others directly affect the outcome. With this as background, I am writing about those last six months of this journey.
Lewis had heart issues from an early age. His first bypass surgery occurred in his early 40s. His second in his 50s and he endured a life of blocked arteries and poor circulation. He worked at the US Postal Service and enjoyed the benefits of an early retirement (age 62) and good health insurance.
You can imagine all the details of a life with a weak heart and I don't really have any great insight into those years. I just know that today's medicine, surgery and healthcare can manage just about anything. We predicted Lewis's demise many times, knowing that he had suffered heart attacks, surgeries, stents, carotid surgeries, the insertion of a pacemaker and then a defibrillator.
It turns out it's just hard to die in America, we know how to prolong life in so many ways, but, it always seemed a kind of miracle when he would bounce back from the latest insult. It was hard not to asses his latest trip to the hospital as possibly his last but he would always come through with an ability to continue to lead a productive retirement life.
That brings me to one of the reasons for writing, the challenges of today's modern medical science. How do loved ones asses the diagnosis and prognosis? How do you plan for someone's future when they and medical science conspire to keep going, forever? When they are at pill number 10. 11, or 12 does that mean their time is near? Surgery number 10? Hospital stay number 10, or even 20?
When Lewis retired he also got divorced. I worked on his divorce to help them divide their assets painlessly and fairly. But in that effort there came decisions that would be effected by Lewis's longevity. How do you predict that? You don't. But you do have to make some judgements to properly divide things like retirement benefits etc. A lump some payment is worth more if you only live a few years while an annuity, paid monthly, is worth more if you live a long time.
I can say now, with the clarity of hindsight, I made the wrong judgement. His ex-wife received the far greater benefit because Lewis lived longer than anyone imagined. After three more years his lump sum distribution became worth less that her annuity. He then lived another seven.
That's just one of the many life decisions that are affected by a loved one's longevity. But there is a lot more to the story. When the end time seems near there are a flurry of these kinds of decisions, and, some more than others directly affect the outcome. With this as background, I am writing about those last six months of this journey.
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