Watkins Good Deaths and Bad Deaths

A Guide to a Graceful Ending
1. Auflage 2020
ISBN: 978-1-0983-0884-1
Verlag: BookBaby
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 100 Seiten

There are many books and articles about the end of life: books about grieving, books and articles about caretaking a loved one, books about hospice, books about coping with conditions that have no cure. Since I'm not a doctor, I read books and articles written by doctors. But I found only a few books and articles about how we, the elderly, could manage to go from here, alive and healthy, to dying a graceful death at home with our family. I learned that this is not easy: there are many bumps in the road along the way. It takes a lot of planning so that we do not end up in a noisy hospital, hooked up with machinery to provide breath and nutrition in our final-often uncomfortable-days, pleading with a doctor to 'do something more'; others will plead 'just let me go.' I hope that this book will be a guide to planning for a graceful ending.

Autoren/Hrsg.

Watkins, Susan

Leseproben

The statistics on end-of-life are terrible. An estimated 40 to 70 percent of dying patients unnecessarily suffer pain, 25 to 35 percent impose significant financial and personal burdens on their families, and 10 to 30 percent express preferences about the dying process that are disregarded by their healthcare providers. 2 Even when the patient wants to die, some doctors insist on doing more and more—even if the patient herself wants to end her suffering. I counted 17 bumps on the road to a graceful ending. So how could we plan to avoid these, such that we could die gracefully, at home with our family? This book is meant to answer that question. Not surprisingly, old people do not want to be old, nor do they want to be seen as old. In the 1950’s, Heinz—well known for its ketchup-- tried marketing “Senior Foods. “This failed spectacularly, poisoning an entire category”. “The same is true for the emergency -response devices that were designed as a neck pendant that summons emergency services when pressed. It is simple and effective. The problem is that no one wants one…The entire penetration in the U.S. of the sixty-five plus market is less than four percent. And a German study showed that, when subscribers fell and remained on the floor for longer than five minutes, they failed to use their devices to summon help eighty-three percent of the time. In other words, many older people would sooner thrash on the floor in distress than press a button—one that may summon assistance but whose real impact is to admit, “I am old”.3 A vivid illustration of the consequences of NOT planning for the end of life happened in my son-in-law’s family. I saw the end stage of his father’s life when my son-in-law and his brothers were visiting their father in a nursing home with round-the-clock care. The father—I will call him Mark—was a highly regarded doctor in his field. When he retired, he continued with hobbies that kept him busy. When he and his wife could no longer manage living alone, they moved to a high-end residence. After a few years, his wife died of Alzheimer’s. Mark continued with his hobbies for several years. When we visited Mark, he was in his 90’s, bed-ridden, a helper was feeding him, and he seemed to barely recognize his three adult children. If this proud man could have looked down from the clouds above, he would have been appalled at being spoon-fed and wearing diapers, and he would have been dismayed to have his three sons see him in that state, their last vision of him. Years before, he had signed a document, a DNR (Do Not Resuscitate) in which a person states that healthcare providers should not perform cardiopulmonary resuscitation (restarting the heart) if his or her heart or breathing stops. This, however, was not his problem: he had seriously infected foot. His three sons were at his bedside, but he had not told them before hand, in person and in documents, what he wanted them to do. They asked him “Do you want to have surgery on your foot?” He nodded yes. “Or do you want to just have the wound cleaned and bandaged?” Again, he nodded yes, leaving his sons uncertain about his wishes. The experience of my son-in-law and his brothers led me to tell my family and physician how I would like to die—and how I would not- rather than leaving it to them to guess. I learned that my son-in-law’s situation is not uncommon—there are many bumps on the road to the end of life—I counted 17 in this book. While many die of old age without hospitalization—their body just slowly shuts down—too often the end of life is marked by a sudden physical failure. Your frail 90-year-old mother is rushed to an ambulance that takes her to a hospital’s Intensive Care Unit, leaving your father and your children uncertain about whether she would have wanted heroic, often miserable, measures to keep her alive for a few more weeks or months—or whether she just would have wanted palliative care while nature takes its course—or both. From day to day, I learned from reading and, by talking with friends and relatives, that those of us in my generation rarely want to talk–-or even think about-- our own dying: death is something that happens to others. Nor may our adult children want to talk about how we want to die—it can be a very difficult conversation. Parents may talk to their children about drugs or sex, but are uneasy about discussing inheritance. But, of course, all of us will die sooner-- or later, if we are lucky. Some of us will go gracefully, like a woman who, after four rounds of chemotherapy, told her family that she was ready to go and died at home with her family around her. But others, like the elderly father of a friend, will fight until the very last minute, lying comatose in a bed in a noisy and busy intensive care unit in a hospital, hooked up with tubes for breathing and nutrition, his family members unsure—and sometimes arguing at her bedside-- about whether she would prefer to continue to fight or whether she would want to end her suffering. And yet others die suddenly, as did Nina, a member of my women’s group at the University of Pennsylvania: on holiday in Alaska with her family, she went to take a nap, but dd not awake. In my effort to plan for the end, I came across many stories of people who fought dying as long as they could. A particularly horrific story comes from Atul Gawande, a surgeon. He wrote of a man in his 60s who had come to the hospital suffering from an incurable cancer. Radiation failed, so it was either comfort care or dangerous, and perhaps fatal, surgery. Nonetheless, the man chose the surgical procedure. He refused to give up: his mother had died on a ventilator, and he didn’t want that to happen to him. Gawande writes that the man had chosen badly… “not because of all the dangers but because the operation didn’t stand a chance of giving him what he really wanted: his continence, his strength, the life he had previously known. He was pursuing little more than a fantasy at risk of a prolonged and terrible death—which was precisely what he got.”4 I also read about people who did not fight. An example is a book by the great Oliver Sacks, a neurologist, a historian of science, a professor and author. At the time of this writing, he had incurable multiple metastases of the liver and had lost one eye. Never the less, he titled his book Gratitude. At eighty, the specter of dementia or stroke looms. A third of one’s contemporaries are dead, and many more with profound mental or physical damage, are trapped in a tragic and minimal existence. At eighty, the marks of decay are all too visible. One’s reactions are a little slower, names more frequently elude one, and one’s energies must be husbanded, but even so, one may often feel full of energy and life and not at all ‘old’. Perhaps, with luck, I will make it, more or less intact, for another few years and be granted the liberty to continue to love and work, the two most important things, Freud insisted, in life.” I do not think of old age as an even grimmer time that one must somehow endure and make the best of, but as a time of leisure and freedom, freed from the factitious urgencies of earlier days, free to explore whatever I wish, and to bind the thoughts and feelings of a lifetime together.” 5 Although I can’t say I’m looking forward to being ninety, likely with a cascade of infirmities—or, worst of all, dementia--I agree with Sacks about now being free to explore whatever I wish—which led to this book. I hope my research will help me, and others approaching the end, to plan for a graceful ending. For me, I would like to try to achieve a peaceful death at home with palliative care: others may choose to fight death in a hospital until the last possible moment, trading off lying in a hospital bed, hooked up with beeping machinery for breathing and nutrition versus the quality of one’s life near it’s end. When I ask friends who are contemporaries whether they have a DNR (Do Not Resuscitate) document on file, some say their advance directive includes a DNR, others clearly don’t want to even think about planning for their death: “It’s too early for that,” they would say. It’s not too early to plan—not least because I think it’s important that my family members and my doctor know what my wishes would be if I reach a stage when I am not able to make decisions on my own. Planning, however, requires more paperwork than a simple DNR. I want some control over the manner of my dying. I do not ever want to live in an institution for the frail elderly, or, worse, be bed-ridden, having to have someone feed me and change my diapers or being hooked up with beeping machines to help me breathe. Most importantly, what are the bumps on the road that I, and others, might encounter? What is the worst that could happen? After reading Atul Gawande’s terrific book, Being Mortal, I started to plan how I could to let go...