Approx 1:30 Saturday morning, December 18, 2010
"I think I need help!"
Mom Joke
The mother is standing outside my bedroom door, gasping for breath and writhing in pain. He says wait one hour before waking.
(Story background: when he arrived last night, Mom told me that sometimes they feel "uncomfortable" for the night knowing that he had suffered a major heart attack a few months ago, I prayed that I be there when it happens again..)
Call 911 and I give themInformation. I say to the animals that are protected and the door is open. I say: "I can not leave my mother's side."
After what seems like 10 minutes, I again call 911. "I am the door," says the dispatcher.
There are two nurses and four firefighters, including the captain of the fire. Some first aid, is asking others to live mom will. I find it and point out that does not mean, not to treat them.
We arrive atHospital treatment, the renowned research and teaching institution. Dr. C. (Cardiologist) and Dr. N., and several other staff members to visit Mom.
I am very enthusiastic about her Advance Directive. In addition, I note that it is not to say, when it is not treated in a coma, and she is not.
"It 'very, very bad," he said. "What would be next?"
In tears, I tell them: "I know what she wants She's a very lucky person who loves the life that is going to be my brother ...for Christmas. His great-grandchildren come to visit next month. You do not want to go anywhere. "
Show me one of the doctors says that some of their living wills do not want to be cared for when in a coma or vegetative state with no hope of recovery. "It is not in a coma," I say. He looks significantly to his motionless form, connected to machines.
If I had my mind on me, maybe I could say something like: "If you are in a 20-year-old football player who ledjust had a massive heart attack, and administered morphine, as sentient think it would be? And you can write off as fast as him? "But you can not form these thoughts, let alone make an expression. I have a feeling that something is wrong with the reasoning of the physician.
It speaks of the possibility of surgery to save her life.
I call my brother Jamie, and his wife Shelly (geriatric nurses). Shelly thinks mom is, to die without surgery. So do doctors. Jamieand give my consent.
Jamie and Shelly are in hospital.
The doctors decided against surgery. Too risky. We agree.
Dr. N. want to discuss the options right there in front of mom, but I read that in a coma -. or apparently in a coma - patients sometimes give up and die if they feel a poor prognosis.
I say "not in front of her," and go to the Quiet Room. Dr. C. reiterates that the operation is not in question. We agree.
Dr. N. want to stopmedical treatment (IV drugs). It tells of an experience in medical school when the professor has made it difficult to breathe for the student, and tells of her terror. He believes that suffering and to ensure that they "never cognitive function."
I want it to her grandchildren and great-grandchildren, and others on their way to see the others here in town. "I do not know," says Dr. N.
"Are you sure?"
He is safe.
Talk more about how to suffer. I do not rememberformulation, but I think there were some signs that already in a vegetative state.
Jamie and I give permission for medical care for the fact that the mother is likely to suffer intensely and will never stop cognitive function. Shortly before he finally allowed, I look to heaven for wisdom and I think the answer is yes I feel.
They maintain the same dosage of the anticoagulant, but lower the dosage of the drug, keep the blood of the motherPressure.
[I call that a miracle has happened, but it can never know, at least not in this life, how it happened. Perhaps Dr. C. was not with Dr. N. before discussing, but still went ahead and did what he knew was right. Or maybe - and this can reduce the probability and - maintained a drug will only be reduced and the other in order to give Mom a peaceful transition, without another cardiac event, which would greatly upset the family. But it happened, I thinkI've heard "yes", not because it was the way to do the treatment, but because the answer, Dr. N. satisfied, and the way to what followed.]
Mom's blood pressure drops. We gather to sing and pray. Through his mask, his mother says: "I have too much to be thankful."
"Thanks for being here with me," he tells each of us - Jamie, Shelly and me.
"I love you, Mom," I say.
"I love you too," he says.
We recite the 23 Psalm. If wecome to mama "Surely goodness and mercy shall follow me all the days of my life," comes in. (She later recalled.)
The chaplain is singing "Be Thou My Vision," Mom favorite hymn.
We sing "Amazing Grace" and "Jesus Loves Me."
I recite John 3:16 ("For God so loved the world ...") and John 1:12 (" How many who have received ...")
"I can not speak very clearly," Mom excused by the mask.
"Yes, it is possible," I reply. "She just said," I can not speakvery clearly. '"He laughs. (Mom remembers more about that later.)
We watch as the mother's blood pressure stabilized, then begins to rise. My nephew is. Mom thanks him for coming. Your sister is coming. You and Mom chat briefly.
Jamie and Shelly is a friend. She came to the last time said he saw in the clinic, and have got a bed at the window wit.
The mask is uncomfortable and can not be done by setting properly. Replace the mask with staffTeeth.
Mom sits down and chat freely. I joke. She laughs, and the monitor shows the deep breathing.
She wonders why all so sad (please note that later) sees, and ... could have breakfast?
After tea with toast and jam, Mom is at heart units to move. My husband, our daughter and son arrive. Mom is very happy to see them, but sorry to bother. Another of our girls and she and her mother phoneshave a nice conversation. Mommy is happy, but just a little 'disappointed that my brother can not connect to the family of Nicaragua on Skype.
You will never again have the cognitive function ... they will not know.
In the afternoon, it was moved to another station. When we go out for the night, his mother says: "I had a wonderful time."
Last Sunday Mom enjoys more visitors and a newspaper crossword.
Monday ', Dr. A, another cardiologist who does hisRound. I ask him: "If a person of 90 years had severe heart attack, has a mother, would say that would never have the cognitive function, based solely on their age and the severity of the attack?"
He looks surprised by the question. "A total loss of cognitive function? Someone said that?"
Yes, I answer, no further details.
No, he replied that he would not say in advance, dass In fact, the mother could be home for Christmas and should be able to continue to live inthe same situation.
You and I enjoy a Christmas carol concert at the clinic in the afternoon.
That night, he ends his introduction to his nephew, proofreading thesis. He found some minor bugs and is looking forward to reading the newspaper when. Miracle Mom is done, when the image of a man is my nephew to write might be useful. He found one on the Internet last year, but can not remember the site. I note the proposal for my nephewPaper.
Christmas Mom writes checks to the grandchildren and great-grandchildren, Jamie, and asks to bring the solution to the puzzle tomorrow.
they do not know
Last Tuesday, a medical student informed us that there are no new significant damage to the heart of this, the mother's second heart attack.
Mom is released Wednesday afternoon. Provides thank you notes, the heart of the station and first aid.
Pity the poor employeeemergency. Even if his mother hands the paper what he thinks, of course, a greeting card envelope, the woman is their health card. (Think that might not have many thank you cards for an emergency?)
My concern with the living will, or at least as we wrote them, are as follows:
1 A doctor can interpret, the early termination of the elderly (my term) favors terms like "coma", "vegetative state" and "no heroic measures" in a way thatNeither we or our loved ones want more.
2 In one case, a little 'different, I have a friend who watched helplessly as his father out of breath. Apparently the instructions of the staff has had a previous record of not using a feeding tube, interpreted as "no action", so they ignored my girlfriend to condemn him oxygen. Finally called 911 and paramedics administered oxygen to the father in the hospital. It 'died a week later, apparently in relative comfort.
UsYou never know, if this man allowed to suffer as it sounds (there's no evidence there of course), because the staff truly believed no one meant gavage without oxygen, or if you just feel that he is an old man with advanced Alzheimer's , whose time was, it was.
My father died the same palliative care facility. He had established "no heroic measures" and received both a feeding tube and oxygen and painkillers. I think he died in relative fitness.Maybe it depends on who is working at night, or if the patient has Alzheimer's, or those with them at that time. Mind father remained unclear and he was able to communicate orally and in writing, until he slipped into a coma the past. In addition, it was very watchful care of the elderly daughter-in-law on his side, along with the rest of us.
I once talked to a nurse who refused to oxygen, patients who have shown clearly asking for the mask, because the instructions said earlier. Theirsaid just take these people and tries to comfort her when she died.
It seems, that can also execute a written advance directive with care in unnecessary suffering and premature death.
The solution to my brother and I believe, is simply a list of agents with full contact information so that decisions can be made at the time.
In any case, we have very, very vigilant when our loved ones do not speak for themselves.
Living Will Warning
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