Wednesday, February 22, 2012

Physicians and end-of-life care – an oxymoron?

A busy life, doting grandmother
The family sits by her bedside. Mother, with Parkinson's Disease, has had it bad lately. Fighting for independence, they fought adult children who tried to find the best living conditions for them.

With a range in services, from Adult Day Away Programs, respite care, Home Care support, to long-term care and hospitalisation, caregiving  decisions must be made with clarity and all information possible.

With several siblings, near and far, they took turns advocating for Mother and Father. With many happy memories of cottage life, embracing the outdoors and healthy living, they enjoyed their large family.

Yesterday morning, Father met them at the hospital. Mother had had a stroke. She was in bed, unresponsive. Life had been hard for him lately. With each new medical complication, this pair married over 60 years, kept telling one another 'once we get over this, things will be the way they were.' But Parkinson's takes its toll. Father was a healthy man, was downhill skiing in his 80s.

The children gathered in the city hospital.
Father had brought in a change of clothes for Mother, for when she would soon leave the hospital. Unfortunately, no one had told him the prognosis. Hooked up to an IV, with paralysis on one side, she would never leave this hospital. Even the layman knew this. Unfortunately, physicians refuse to deal with reality in these cases.

How can physicians be so cold? Whether it be those in the ER, or the GP, they still refrain from using their experiences to educate patients. Life is like a hotel. We all check in but we all check out at some point. Better in our twilight years, with a good life behind us. But this is not always the case.

She had slept on this side of the bed for 60 years.
He rested.

We know they cannot predict timelines for end-of-life, but they need to be honest about the signs and the significance of particular trauma, like a stroke, in an elderly or frail patient.

It is beyond the Scope of Practice for nurses, yet they are the ones who develop a rapport as they provide intimate daily care for loved ones. Perhaps the nurses should be more involved.
For failing seniors facing this issue, the loss of a spouse of six decades, of shaping a life through marriage, careers, raising children, enjoying grandchildren, is still a complete shock.
Do they not deserve honesty, truth, and the truth that experience gives a wise physician? Patients with multiple co-morbidities may or may not be able emotionally and cognitively to face truth. Spouses and family members need to know.

The family demanded the physician sit down with them, and Father, and lay it out. Goodbyes had to be said, arrangements made. Father would need a new plan.

Sadly, it was the next day that Mother passed over. Father was better prepared with the intervention of his adult children.
The day of death should not be mourned. They celebrate a life well-lived; a woman well-loved.
Physicians must learn honesty, transparency, and know that we only rent these bodies. Families who pregrieve, who come together in anticipatory grief, are better prepared for what the future will bring.

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