“Illness gives us that rarest thing in the world-
a second chance, not only at health but at life itself.”
They called me to see her because she was critically ill. She had done very well for a woman in her early eighties. She lived by herself, ate well, was able to drive to the supermarket and the hair salon, and had no trouble with personal care. One day she developed a cough; the next a fever. Within three days she was gasping for breath and she could barely move.
The diagnosis was pneumonia. Her chest X ray showed numerous patches where the air spaces had been taken over by what we call infiltrates. She was given two powerful antibiotics and did not improve. In fact, she got worse by the day. Because of the lack of response to antibiotics, additional tests were done. I was called because they signaled the presence of a severe autoimmune disease.
When I got to intensive care they had placed a tube down her throat to help us keep enough oxygen in her system. Of course, she could not talk, and she was heavily sedated. I had my work cut out for me.
I asked the nurse to find me a family member that I could talk to. I was not sure that she would survive. She had a great-niece that came to visit every day. My patient had never married; there were no children and no surviving siblings.
The niece was a very pleasant, well-educated young woman. She understood the gravity of the situation, and showed quite a bit of concern. Her fiancé lived with her and was also very supportive. I could see that these two relatives would be of great help if we could get her better.
Which she did, and how! She tolerated huge doses of cortisone without a hitch. She did not develop any side effects to the powerful immunosuppressive medicine that was prescribed. Within two days, she was breathing on her own. Within a week she could walk and feed herself.
She was doing too well to go to a rehab unit, and her niece would not allow her to go to a nursing home. The young couple took her in until she was strong enough to be able to go home. This temporary arrangement lasted for years. The young couple did not find her to be a burden, and she found out that she did not look forward to being alone after the scare that she had gone through. She sold her home and rewarded her niece so well that they were able to buy a bigger home that provided ample room for the three of them. They frequently went out as a group. A dog joined the household. At one point my patient told me that these were some of the best years of her life.
When she reached her late eighties time began to take its toll. She developed a painful neuropathy of her feet. The disease robbed her of her strength and coordination. She often felt that she was about to fall. She could not sleep because of the pain. She did not want to leave the house because she was afraid of falling in a public place.
She tolerated these problems with exemplary courage, but I could tell that she was worried about what would become of her. Her concerns were well- founded. Soon she developed incontinence, both of stool and urine. She could not walk three steps without leaking. Her niece and her (by now) husband did a great job of cleaning after her, without a hint of complaint, but the embarrassment was too much for her to bear.
She fell one more time. They brought her to the office; clearly a worn-out and defeated woman. Gone was her well-done hair; her fashionable blouse; what she used to refer to as her sexy slacks. She wore pajamas, which were a bit soiled. They had to wheel her in.
We went over her ailments once again, and her exam showed nothing except the devastating loss of nerve function below her waist. She was in tears.
I said something about trying to find a nursing home. Her niece and her husband both said that they would somehow make it work without placing her in an institution. Their concern was how depressed and ashamed my patient was.
I held her hand; I tried to get her to establish eye contact with me. She could not stop crying. After a minute she finally spoke.
“Why did you save me?”
Loud. Angry. Almost spiteful.
An excellent question. For one of the few times in my career, I had nothing to say that I thought would help. I lowered my head and I held her hand a bit longer.
They took her back home. Her niece called three days later. My patient had fallen again. She refused to eat, and she did not want to go to a hospital. I sent a prescription for pain medicine, in case that she would need it. She died within four days.
Why do we save older people? Because she had a treatable illness; because she recovered and had a wonderful time after she healed. Because she had a support system: people who loved her and went way out of their way to help.
Yet I knew all along that her eventual slow and painful deterioration was a distinct possibility, given her age and the presence of a life-threatening autoimmune disease.
When do we say no? How can we tell if a patient has a few good years left, or if they will end up angry with us because we saved them?
I still feel her anger. When I think of her, even after all these years, I cannot think of anything that I could have said to her; no words that could lessen her pain. There are days that I bring up a mental image of that visit. I always end up looking away from her while I hold her hand, speechless. My only consolation being that we gave her a second chance at life, unaware of the consequences.
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You made a bet. It did not have the best payoff. As any betting man would tell you, it is all about how you did when you cashed in. I suspect that you have had more wins than loses and that is how you shoud go on.
I understand how helpless sick and old people are. I went home to Canada and rented a cottage so I could spend my mother’s last days with her. When I arrieved at the hospital that my mother was in, my sister was in the same one. She had just taken a stock. I went from my sister’s room to my mother’s holding back my tears . I spent three months to be there for them. I was at my mother’s bedside when she passed away.The nuse told me to keep talking to my mother that she would be able to hear my voice. I talked long afer she was gone. I sat by her and prayed and told her how much I loved her. I sat alone by her for a long time taking her face in so I could have a lasting memory of our last moment together.
A few days before she passed away. My son Kim and asked permission to take her for a ride in our van. He carred her frail body out to the car, and set her in a seat beside me. She saw the trees in blossom for the last time in her life. She loved nature, and was so happy to see the blossoms. We drove her all ove her little town of Cobalt, Took her by her home she had to leave. On our way back to the hopsital we had a picnick int the car. Got her some fish and chips at a little chip stand, and then took her back to the hopsital. I thank God for letting my mother spend such a beautiful last day with Kim and I, I thank Kim for being able to lift her into the car.
My sister got well enough to go home. She is still doing fairly well. She has problems with one leg. We never left ot go back home until wer knew my sister was out of danger.
Bob, Kim and I went home earlier to take care of his half sister Adela when took a heat attack. she was the same age as my mohter. She never had a family. and her husband who loved her dealy had passed away. We took good care of her and never left until she was doing okay. That was a few years before she died.
Not long after my mother passed away, we were called home again ,Bob’s half sister Adela was in the same hospital, she was dying of Kindey failure. I sent hours with her by her bedside. I loved her very miuch. Many years ago she worked for Eaton’s order office in our small town of Haileybury, she took me under her wing and gave me a part time job at Christmas and Easter so I could buy gifts for my children at Christmas and Easter. She was the manager. She taught me how to make change, and do my job. I was most grateful for her help. Bob and I loved her dearly, she was a second mother to us both.
She stopped eating and drinking.when she was getting very depressed about her situation, she said she just wanted to die, she did not want to live like this anyymore One night when she was very low. I rubbed my my hand over her lovely hair to comfort her. The nuse was came into the room and she heard Adela call me mom. I said to the nuse did you hear what she said. She replied She believes her mohter is with her now and I am sure she is. Adela died sometime late into that night. I was happy I was there for her. We all miss her,. she was a story teller and I listened to her true stories while Bob was playing golf with fiiends. We took Adela out to dine many times with my mom when we went home. We miss both of them.
I thank God that we could be there for them. The nurse at the hospital said to me you are a very stong person to go through all the saddness. I told her God puts us where we are needed.
At the time, it was the right thing to do.
Saving her was the only choice you could make. Her anger was not really her, but what her mind became when she became older. You see this often with loved ones in nursing homes. When you did save her she was grateful and that is what keeps all of us going.
You did your best according to your consciousness. She was fortunate to have good caretakers. That extra time was to work on her humility. Pride is good while you are independent, sooner or later all of us must surrender.
Really good Doctors will always try to help. The lady recovered and had a number of good years. None of us know just when it’s the right time to let go. God is the one to determine our time. We may never know what or why we are still here.
You did the right thing because you are a good doctor, but most of all a good person. She had several good years left.I am sure her niece and husband were very happy for this time with her and for her.