Bedtime

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“A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist.” – Stewart Alsop

Yesterday in conversation with the woman across the street I learned that unbeknownst to me, a neighbor down the way had died a few months back, leaving his wife physically unable to care for herself despite being in full control of her mental faculties.

Being in full control of her mental faculties does not, however, ensure that you make good decisions. In her case, she had checked herself out of the nursing home she had resided in for a few months and moved herself back in to the house the night before. The rest of the family lives anywhere from 1.5 to 3.5 hrs away.

Her closest living son and daughter-in-law were present at the time with my neighbor, discussing the situation. During the course of the conversation, the son made a few off color comments, one being, “So, Doc, how much hydrocodone do I give to kill her?”

He was semi serious.

I feel for this woman. Sometimes family is too close to the matter, weighing the burden and imposition on their own lives, to really give a chance of understanding. Truly, she probably wants to die there and if it happened tomorrow, she would be at peace with that.

But how do you reconcile this fear of a loss of freedom on both sides of the coin?

They want her in a nursing home. She knows full well if she goes in, she is not ever coming out alive. She will have to condense her entire lifetime of memories and belongings into two shoeboxes and relinquish control of every aspect of her remaining life to people who care nothing for her, people who want to constantly control her peeing and pooping and eating and mood/behavior.

I have been through this countless times with my own patients. I have been the bully doctor laying down the law and the cajoling bargainer serving as go-between. Whatever it took to get the deed done. You would think I would have some profound bit of sage advice, but I had no good answers for them. None at all.

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28 thoughts on “Bedtime

  1. It’s a tough situation. My own mother did not want to move into an apartment until it was too late. Perhaps she also wanted to die in her own home but her home wasn’t set up for convenience. There was no bathroom on the first floor. The steps were steep. None of us could move back in with her nor would she move in with us. Ultimately she died in the hospital. While the house didn’t kill her, it didn’t help her either. Sometimes they make their own decisions and unless they have dementia, you have to roll with it.

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    • Absolutely! Being of sound mind does not mean you make the best choice. But then, I wonder, if it were me and I was prolonging my life in an awful state, I would rather die quicker in my own home than languor on in a nursing home? I fear my children will have to drag me kicking and screaming…

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  2. End-of-life care is so hard for everyone involved. Do you put them in a facility where they will get care but not love, or do you keep them at home where they will have love but possibly not the level of care required? I was fortunate that my own mother was aware enough to make her own decision to go into a “rest home” once she knew she could no longer take care of herself. She told us she was “ready to go” and didn’t want to be a burden to her children.
    She seemed content to have others cook and clean for her. Of course, we all kept tabs on her care and her mental state, and we were all there when she took her last breath just a few weeks shy of her 92nd birthday.

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  3. One of the numerous downfalls of this world is that we no longer respect or wish to take care of our old. This is a very sad thing, I lost my mom at 51yrs old so I never had the opportunity to be in that position. I have started laying the guilt on early to my kids. If they cant’ care for me I want a home with all of the bells and whistles, where I can wear crown if I choose to! πŸ™‚

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  4. I believe a doctors roll is to advise and guide us toward wiser living and when the time comes that healing is not an option they serve to guide and ease our pain toward a peaceful exit. It isn’t assisting in a death to accept the natural course of a life’s end and be there to comfort the patient along the way. I’ve seen doctors walk that line well and it’s a beautiful gift to the patient and the family when they do.

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  5. I like the quote about the sleeping and dying man. We are frequently made to be the “bad guy” when a family is too scared to raise the issue. In the UK patients get kept in hospital following an acute admission, we don’t discharge them home if they aren’t safe and instead they are forced to go into a nursing home. They have no autonomy or control. It’s wretched.

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  6. This is a hard one. It frustrates me when patients don’t have the insight that they are unable to look after themselves at home and is a burden on others…. And yet I understand their dear of being in a place where they have no autonomy.

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  7. Bless my crazy parents that live only 10 minutes away. They are in their mid seventies and talk about how much time they have left in a cheeky kind of way. I tell them I’m going to spend all their money making the house handicap accessible, getting someone to clean once a week, and taking them on small field trips twice a week.

    In all seriousness, I hope they go together. Watching one or the other survive and try to cope with the overwhelming sorrow will do me in more than anything.

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  8. This is the nightmare of my job. I work in protective services, for adults over the age of 60. This is a common story of my work life every single day. Some agencies believe in “freedom over safety”. Some, do not. I know when I go to work every single day that I am dealing with this, every single day. It never gets easier.

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