A Lack of Clarity

As I laid in bed trying to sleep and not disturb the Wife or the sleeping animals on the covers I heard a garbled voice on the answering machine. Phone calls in the early morning hours are never good. The 83 year old Mother-in-law has been in the hospital for the past month with one thing after another, so it wasn’t exactly a surprise when I crept out of bed, listened to the message and called the hospital back. “It’s family,” the nurse said as she handed it to the doctor. He needed to speak to the Wife and had left messages on her cell phone. I said that she was asleep; he didn’t object when I said I would wake her.

Her family had once numbered over a dozen, now the Wife was the only one left to make life and death decisions over the fate of her mother.  Her father, a retired research chemist at Du Pont, died three years ago. Her eldest brother had died of diabetes complications thirty years ago. Her youngest brother drifted into madness of mindless matings with women and religious cults of one sort or another. Her sister, my last drinking buddy before I went into recovery, now resided in Las Vegas with her co-dependent. Once she had learned that her mother was in the hospital she had stopped calling; reality tends to interfere with one’s alcohol-fueled fantasies. Her two children, newly-minted adults both, haven’t called or visited their grandmother in months. One, who graduated high school in June, works at the local Target when not at college. We say “hi” to each other as we pass in the aisles as our familial relationship withers.

So it was left to my Wife while speeding on a highway patrolled by the occasional Delaware State Trooper and the lone drunk driver to make a critical decision.  Her mother’s oxygen level was dropping and they needed to place her on a ventilator . “But she’s signed a DNR,” she said. There’s no DNR on file she was told. The pressurized mask was failing to keep her blood O2 level up. Intubation was the only option. Would she authorize it?

Somewhere on a darkened stretch of I-95 the Wife relented and agreed. By the time she arrived minutes later she found her mother sedated and on the vent. Sure enough the DNR bracelet she had worn prior was missing from her arm.

When she met the hospitalist she learned that her mother had screamed, and the nurse rushed to her bed and found her short of breath and struggling to breathe. “Call my daughter,” she said before sliding into unconsciousness, “I want to say good-bye.”
The Intensive Care Unit (ICU) at the local hospital is a completely separate unit. Once a doctor signs off on the patient, he or she is wheeled through a set of locked double doors into a cluster of small vestibules facing the nurse’s station. A new team of doctors and nurses takes over control, and the hospitalist who had cared for a patient often may never see him or her again. Within each vestibule lays a patient attached to a tree-like stand of monitors and machines by roots of electronic leads and plastic tubes.These are the sickest of the sick, I later explain to the Kid. Anyone sicker than this dies. A bearded old man lays in one vestibule next to the Mother-in-law; on the other side of her lays an elderly black woman curled up in a loose fetal position. All lay sedated and are completely oblivious as the doctors and nurses pass from one to the other, checking vital signs or changing settings on one of the machines on the “tree”.

Fluids of various colors hang from branches of the tree. Some drip into my mother-in-law while others are collected below her bed as she lays asleep, mouth slightly open from the ventilator tube that causes her chest to rise and fall rhythmically, a barely perceptible hiss in between each “breath”. I notice that one electronic monitor reads “12:00” like VCRs used throughout American households until they were replaced by DVDs and Tivos.

The Kid steps hesitantly towards his grandmother, and slowly takes her hand. “I love you,” he says, a hint of emotion to his voice as he squeezes her hand. She doesn’t respond, nor does she make any movement when her daughter leans close to her and whispers “I love you mom,” into her ear. I stand out of the way beyond the head of the bed next to the “tree,” allowing my curiousity to stand in the way of an inappropriate emotional moment.

As I examine the finely crafted tubes and machines, each the result of precise application of engineering and science, I’m left to wonder at the conundrum we now find ourselves in – “we” as a society as well as “we” the family. While my mother-in-law and I do not get along for reasons that I’ve never quite understood, I wish her no harm. Yet I recognize the question that my Wife must answer alone, and the larger one our society must grapple with.

When is it enough?

A mastectomy leads to a colon resection leads to possible sepsis in an 83 year old woman. Where is the line that says simply, enough?

Try as we might we desperately look for it but it’s nowhere to be found. In our case the Mother-in-law can survive the sepsis and slowly gather her strength. As she becomes stronger she can move to a rehab a facility and by the Holidays could be busying about her daily life as independently as she was before the breast cancer.

Or God could take another pot-shot at her and she could become sick with something else.

If there is a line that we cross that says clearly, emphatically, “that’s enough,” we have yet to see it. Unfortunately its lack is making us question the lines very existence.

One of the more painful arguments I had on this website came from my unwavering support of Terry Schiavo-Schindler family’s fight to keep her alive. I don’t regret my support of her family against her husband, and while I believe her case to be fundamentally different than my mother-in-law’s I do think it holds some similarities. For one thing in Schiavo-Schindler’s case there were no definitive lines (although her husband and his attorney would disagree) just as there aren’t any today with my mother-in-law’s condition. My mother-in-law is also 83 years old; she’s live longer than most people born the same year she was.  

So without the lines, without the clarity that they bring we are left to weigh in the end, what she would want us to do. This is what the Wife is doing as she carries the burden of making the decisions for her mother’s care. All I can do is listen to her, agree with her opinions and rub her back as she unloads the burden for a few minutes.

Her mother doesn’t know it but she is in the best of hands.

More to (surely) come…

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  1. Watcher of Weasels » Weasels vs Watchers Council: Submissions in a War on Truth:

    [...] The Razor – A Lack of Clarity [...]

  2. Cheat Seeking Missiles » Wednesday Reading:

    [...] The Razor – A Lack of Clarity [...]

  3. soccer dad:

    The big problem is the Cruzan decision that treats nutrition as an extraordinary measure.

    I think that James Q. Wilson captured much of the ambivalence that you wrote about so well here.

  4. Scott Kirwin:

    Thanks for the link. I’m still troubled by Terry’s death believing it to be the end result of a grave injustice. The earth is filled with injustice, someone once commented to me, why are you so angered by hers?

    Why not? I answered.

  5. The Glittering Eye » Blog Archive » Eye on the Watcher’s Council:

    [...] The Razor, “A Lack of Clarity” [...]

  6. Bookworm:

    It’s so difficult to find the line between extraordinary care, where medicine often outstrips day to day reality, and ordinary care, which is to make a body comfortable as it makes its journey . . . somewhere. It’s also so difficult to decide when in someone’s life one should draw that line. Fortunately, in America, it’s still a family decision driven by morals, rather than one driven by a dollar conscious state—although it makes it no easier for the family facing that challenge.

    My best to all of you.

  7. Watcher of Weasels » Winners On a Day of Financial and Political Turmoil:

    [...] Second place with 1 1/3 votes – The Razor – A Lack of Clarity [...]

  8. The Glittering Eye » Blog Archive » The Council Has Spoken!:

    [...] the financial crisis, “Don’t Just Do Something, Stand There”. Second place honors went to The Razor for “A Lack of Clarity”, about a family crisis and the quandary of how much medical [...]

  9. Cheat Seeking Missiles » Watcher’s Winners - Meltdown Edition:

    [...] in second was The Razor’s A Lack of Clarity, which was not about Wall Street or the election, but about trying to identify the fine line [...]

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