Late Night Death Panel Discussions

Though she was only 61 years old, she appeared twenty years older. The two years prior to her death were punctuated with numerous trips in and out of the hospital. Smoking had been the love of her life and she did not want to part with it. Turning off her oxygen to smoke was her tortured routine.

Her skin was bloated from steroids and paper thin; bruises dotted her arms and legs like a lavender mosaic. My mother was a train wreck barreling down the track, and there was no way to stop it.

When she finally quit smoking and drinking and was too weak to even walk to the car unaided, we went again to the emergency room because her lungs were failing. The young resident took her medical history and with each question she answered with halting breath and a resigned attitude. Do you smoke? he asked. “ No” Do you drink alcohol? “No”. Do you do any street drugs? “No”

Without missing a beat she looked at this young pup and said “No I don’t smoke or drink and honey, I gotta tell ya, clean livin isn’t what it’s cracked up to be!” The poor young doc didn’t know what to say.

So now my mother was admitted once again to the hospital, but this time the diuretics and breathing treatments weren’t working very well. Her raspy cough and labored breathing seemed to accelerate. I sensed she was more fearful than usual so I ventured out on a limb to ask her what her worst fears were. She didn’t have to think twice: a ventilator.

What happened next could be categorized as a death panel discussion by some who are ignorant of the beauty of such an interaction. I called the respiratory therapist and asked if she would come to the bedside for a frank discussion. When the therapist arrived my mother asked some very hard questions and made it clear that she wanted honest answers. We talked about ventilators, and lung disease, quality of life and alternatives. She asked about the option of not treating and the consequences. The truth is hard to hear, but the unknown is worse. After about twenty minutes, all of my mother’s questions had been answered and we had a plan.

It was the first time I had seen peace on her tired face instead of anxiety in a long time. She understood the choices and could see down the road what was ahead of her. She knew clearly that she did not want to be intubated and be placed on a respirator no matter how bad it got.

I called the nurse into the room and asked that she make note of the fact that my mother did not want to be intubated, but I also asked that she get standing orders for Xanax and Roxinol or Morphine, all of which are used to help with end of life pain and difficulty breathing. My mother could now rest easier knowing that she would not be thrown to the whim of a third year resident or the fears of a family member if her health suddenly took a dive. She had decided how she wanted to play her hand, and hoped to stay in the game a bit longer.

These conversations about death are so important because if we don’t have them before an untimely event, we could be in a position to have decisions made for us that we do not want. Or worse, we put our loved ones in a position to make choices for us that they don’t deserve.

I had one friend ask me to be her Power of Attorney for healthcare matters in case her husband is not available. She looked at me dead serious and said: “I expect you to stand on the hose if you have to but don’t keep me alive on machines!”

If these intimate, informative conversations could take place more and more, the fear of death would have less bite for many people with chronic illness. You can’t control the disease, but having some control over how far you want to treat it is priceless.

Death Panels or frank discussions, you decide, but I’m glad that my mother had some sense of peace in those last weeks before she died. She knew her body would eventually fail her but she trusted that the plan we had put in place would not.