Whether they are young or old, we do not want our loved ones to die. Period. Even if we live with faith in our eventual, eternal reunion with them, we know that their passage will leave a void. I completely understand.
But I want to take a few lines to try and make things clearer, or easier, for those who have family members who are very aged and infirm. You see, I am privileged to care for many seniors in the emergency department where I work. And a large number of those I see come from nursing homes. Furthermore, many have severe illnesses that have left them debilitated, such as profound dementia, life-changing strokes or heart failure, cancer, kidney disease and various physical ailments.
Very often, when they become acutely worse, they are sent to hospital emergency rooms. Sometimes, this is due to the concern of family members. Other times it is due to the policies of the facility where they reside. But all too often, the trip to the ER and the evaluation there is uncomfortable and frightening for those patients in the final phases of life. And the expectations that come with those experiences are unrealistic.
It isn’t that they cannot, or shouldn’t, be treated. It’s easy enough to give fluids to the dehydrated, to treat the pneumonia or urinary tract infection.
But what I want everyone to think about, when their elderly loved one is sent to the ER, are these things: 1) What do I want to have done? 2) What outcome do I hope to see in my family member? 3) What am I willing to put that person through? And 4) what would they realistically want if they could say?
For example, when the sweet, 95-year-old lady with dementia has a heart attack, will her family want her taken to the cardiac catheterization lab for a procedure? Even if they say yes, the cardiologist will likely say no, due to the level of risk involved. She may or may not survive the event, but the procedure may be just as bad. And if the 85-year-old, bed-ridden gentleman with multiple strokes falls, and hits his head and has a hemorrhage in his brain, will the family expect him to have a craniotomy (open brain surgery) for the injury? Will there be a net improvement in his life, or an extension of his years? Will the darling great-aunt with heart failure and pneumonia survive the month on a ventilator? And would she want it?
Please understand that I’m not advocating “mercy killing” or anything as nefarious as that. I want everyone to have as much time, and as much quality of life, as possible. But we need to be merciful and realistic. And even those working in nursing home facilities need to be practical. A nurse once told me that she wanted an elderly patient taken to the ER for pneumonia, against her family’s wishes. I asked her, “How do you want to die?”
Her answer was telling: “Why, of old age, of course!”
We don’t really get to die of old age. We all die of something. But we can die with dignity and comfort. And our loved ones deserve a chance to die without unnecessary interventions born of unnecessary guilt or false expectations.
Edwin Leap is an emergency physician who blogs at edwinleap.com and is the author of The Practice Test.
