Friday, December 28, 2012

When it rains, it pours.

Christmas at the Munday household this year has been marked by tough times and tough decisions.  

Chris and I went to Illinois for Christmas to see our mothers (mine is 92 and in a nursing home).  We noticed that my mother had a bandage on her left foot (apparently the result of an infection) and were told that the staff were watching it carefully.  The next day they told us that the infection had taken a turn for the worse and they were sending her to the hospital.  A surgeon cleaned out the wound and removed some diseased tissue.  

Today, I got a call from the "palliative care nurse" who wanted "to go over our options."  One option consisted of continuing to aggressively treat the infection.  The other option was to "move her to hospice care and keep her comfortable until she passes."  Imagine--letting a 92 year old woman die because of a foot infection!  I think the irritation (not to say anger) must have shown in my voice as I explained that, no, we would not be taking that option, and that they should continue to treat her infection by every appropriate means, including surgery, if necessary.

As we continued to talk, the nurse discovered that she was looking at a page from someone else's file when it came to knowing what insurance coverage my mother had.  When the nurse discovered that my mother had not only Medicare but private health insurance, suddenly it seemed they were more willing to do whatever was necessary.  In the three hours since that call, I have received calls from the admitting physician at the hospital and the surgeon who will intervene surgically if the infection doesn't improve, and it appears we may be faced with a decision in the next few days about amputation of part of my mother's left leg.

I think there are at least two lessons here: (1) As healthcare in America deteriorates, only those who can pay for it are going to get the level of care and compassion that we used to extend to everyone.  And, (2) those of us who are pro-life are going to have to insist on not taking the easy way out when it comes to how we care for the elderly, the young and vulnerable, and ourselves. 

I am still in shock to think that, if I had given a different answer a few hours ago, my mother would, right now, be moved out of the hospital to a place where she would be getting only palliative care until she died. 

Parenthetically, let me say that I know the flip side of this: that you can prolong someone's suffering unnecessarily by using extraordinary means to keep them alive; and that hospitals might be willing to employ extraordinary measures on someone with private insurance or private means in order to take in more money.  I am aware of that, but that is not what we are talking about here. 

I am also pondering what impact it might have had if my mother had signed an "advanced directives" form in years past.  Could it have affected whether we were even presented with options now, or what the options might have been.  If there had been an "advanced directives" form on file, would I have even been consulted? 

Of course, we don't know how this is going to end, and we know that someday my mother, like everyone, will die.  For the immediate future we can expect our anxiety level to rise every time the phone rings.  But we know this: no one we love and care about is going to die simply because it is easier and less costly for us to let things go that way.  In other words, no one we can save through appropriate means is going to die by choice. 

If you think of it, please pray for Kathryn.



Tregonsee said...

When a country moves to government medicine, whether you call it socialized medicine, single payer, or something else, it takes about a generation for the quality of care to deteriorate to the nightmare of, say, the British system. Your experience shows that it is already starting.

Free Range Anglican said...

I'm sorry to hear about your mother's illness... You're right that its not about whether she lives or dies at a given point; its about how a son honors his mother and a culture honors life. In that, its about giving all of us a reason to live. Love to your mom.

Robert S. Munday said...

Tregonsee, Yes, I resisted the temptation to comment on the current political situation as it pertains to healthcare. But if we were dealing with this after Obamacare kicks in, there would be another decision maker in the process--namely a government bureaucrat--deciding what care my mother would be allowed under the "Affordable Care Act." There are already patients who need kidney dialysis and are being refused under new Medicare guidelines because they are over a certain age.

Someone taught me long ago that Liberalism always accomplishes the opposite of its stated intent. Rather than universal health care making health care more available, it is going to make the kind of health care this country has known in the past rarer for everyone. Rationing, death panels--it's all there, only those who are mesmerized by Obama refuse to see it. And I am not sure they will recognize what a failure Obamacare is even when it hits them in the face.

Robert S. Munday said...

Free Range Anglican, Thanks for your prayers. As an update: I just got off the phone with the surgeon. My mother did have to have an amputation of her left leg just above the knee. But the surgery went well, and she is okay otherwise. However, knowing my mother, when she comes out from under the anesthesia, she is not going to handle the loss of a limb well. So she still needs lots of prayer.

Donald said...

AS a lawyer (Father, forgive me, for I have sinned!) I think advanced directives are a very wise thing, but they must be thoughtfully prepared, while you're healthy. It's all too easy to glibly say "no hydration or nutrition" when the idea of death is theoretical.
Several years ago (during the Terry Schiavo debacle) a physician came to me for a living will. He said "If I'm terminally ill I want hydration but not nutrition. If the body is in the process of dying, depriving it of nutrition does not cause suffering, but depriving it of hydration can cause suffering." (you die of dehydration). I share this opinion with my clients as it makes a lot of sense to me.
But if your Mom had made an advanced directive, she could have specifically appointed you as the one to make health care decisions for her in the event she's not able to. When she gets better talk to her about doing one.
I'll be praying for you and your Mom.

Unknown said...

I will pray for your Mother's comfort and good care. I made an advanced directive several years ago, and asked for hydration, but not nutrition...if I get to that condition. I also asked for pain relief, even if it should contribute to my life being somewhat shortened.
In addition, I drafted a statement to my children (I have 3), in my own words, and reminded them of my faith and my fear of lingering in pain, and that my constant prayer is that they always love and support each other. Then I made copies & sent it all to each of them.
I am now 81, and I wouldn't change a word of it.
May God bless you and your mother.

john said...

Hope all is well.