Letter from Langdon: Endings

Rumors, misunderstanding, and "strategies" walk in where mere mortals fear to tread. Can we talk about dying?

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When Margaret (not her real name) told me that the Obama health care proposals contained sinister plans for “youth in Asia,” I was puzzled. Were we planning to import low-paid juveniles from the Third World to subsidize the health care industry? (I think we already have: every large urban hospital I’ve been in over the last ten years is cleaned by Asian workers.)

It turns out my ringing ears had betrayed me again. Margaret didn’t say “Youth in Asia.” She was talking about the Kevorkian practice of ending life, known as “euthanasia.”

In some parts of the country they call unfounded rumors lies. But if a lie has political origins, it’s called a “strategy.” Claims that euthanasia is part of the proposed health care reform are political “strategies.” They’re rumors started by folks who like things just the way they are.

I investigated Margaret’s claim, and what I think she was talking about was a provision for counseling about options at the end of life. That’s a new sounding term for a very old concept — that sometimes it’s best just to let nature take its course.

I consider life’s beginning with birth and ending with death
inescapable facts. While birth is nearly always a joyful event, the fact
of death is never pleasant.

When our father passed away 15 years ago, my sister and I were spared the decision of whether or not to prolong Dad’s life because our mother was in charge. Dad had had a series of strokes that affected his mind and left him partially disabled. High blood pressure and arterial disease were his diagnoses.

On the day he died, Dad’s blood pressure shot up inexplicably in spite of medications. He was in pain from a burst artery in his groin, a result of high blood pressure, and the doctors said surgery was impossible because of the location of the aneurysm and Dad’s overall condition. When Mother asked if there were anything we could do, the doctor said we could mange Dad’s pain. Pain killers were administered, and nature took its course.

Ralph and Merry Oswald, 1970

Both Mother and Dad had living wills stating they should not be kept alive by extraordinary means. Mother often talked about whether or not she had done right by Dad on the day he died. It weighed on her, but Sis and I always reminded her that Dad had made the choice in his will.

In my experience, the Greatest Generation seldom uses counseling even when they should. But all of us tend to revisit hard decisions, asking ourselves if somehow things might have been different. That’s why counseling about life or death alternatives is so important.

Mother lived for several years more until she started having difficulties. When we went to the doctor, he discovered that her aortic heart valve wasn’t sealing properly. We were referred to a specialist. His diagnosis was that her valve had been scarred by rheumatic fever, a disease she’d had as a child. He referred us to a surgeon who examined her and declared her unfit for surgery. “If she were my mother,” the surgeon said, “I’d tell her to go home and enjoy what time she has left.”

That was just before Christmas in the year 2000.

Mother’s parents named her Merry. Her birthday fell in mid-December, and she took her name to heart. Christmas at our house was always a joyous occasion. As Dickens once said, she “always kept the holiday well.”

But Christmas 2000 wasn’t very joyous. The winter was marked by trips to the emergency room when Mother had trouble breathing. When one of the physicians, Dr. Zaruba, asked about the possibility of surgery to correct her problem, we told him of the prognosis offered by the surgeon in Omaha. He suggested we see a different group of surgeons in Lincoln, Nebraska.

The doctor in Lincoln saw no problem with open heart surgery. With relief, Mother accepted his assessment, and she received a new heart valve a few days later. The surgery was difficult and her recovery was slow. Eventually she did leave the hospitals and nursing homes and return to her own home, but age-related sight and hearing losses, and a heart that never managed fully to recover kept her from enjoying life the way she once had.

Merry and Ralph Oswald, 1968

We still went to the emergency room with Mother for sudden bouts of pneumonia and other problems until something that doctors thought might be cancer showed up. Gradually she lost the strength to stand and it was difficult for her to eat. She was too weak for surgery, radiation, or chemotherapy. Of five doctors who saw her, none gave us hope for recovery. That’s when the doctors and nurses suggested counseling about hospice.

My sister and I agreed to talk to a representative from Tabitha, a service of the Evangelical Lutheran Church in America that offers hospice care.

The lady from Tabitha explained that under hospice rules Mother would continue to be kept as comfortable as possible. She would eat when hungry, drink when thirsty, and be given pain medication. She would be bathed and cared for in every way, but treatment for her illnesses would cease. In other words, she’d be allowed to die as comfortably as possible, with dignity.

Early on in hospice, we had time to talk with Mother, to reminisce and to thank her for her love and care. As her illness progressed conversations became rare and she lapsed into a semi-coma.

Even after she no longer acknowledged my sister and me in the room, we could hear her singing softly to herself. I couldn’t make out the words, but they sounded like hymns she used to sing in the church choir when I was a kid.

A few days after entering hospice, Merry Oswald passed peacefully.

Ralph and Merry Oswald, 1936

I know the health care debate has stirred strong emotions. Writing this has certainly stirred them in me. But for some to distort the truth about counseling and hospice (a practice that’s been used for generations, just called by different names) in an effort to control political events is wrong — especially when families who must face the inevitability of death need good information to make hard decisions about the people they love. I think that’s what President Obama was trying to convey when he talked about the recent death of his grandmother.

Critics of health care reform should set misleading strategies aside and focus on the truth. In no way should hospice counseling be considered euthanasia. Coverage of hospice counseling and care should be included in any serious national health care proposal. If opponents of health care reform can’t win the debate with the truth, then maybe they’re just plain wrong.

 

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