Tuesday, February 5, 2008

A Death

If an elderly relative has an advance directive, or living will, you may think his death will be a smooth passage.
Don’t count on it.
Certainly, it will be smoother for you than for him. You’re watching. He’s watching, too, from inside, through an undefinable mental haze.
You can leave his room after a few minutes when watching becomes too uncomfortable.
He can’t. He lies with the pain, perhaps one of the only feelings or emotions that he still possesses.
Being with him is slightly terrifying because you’re never sure when he may awaken. He groans, cries, tries to rip off bandages and throws punches at nurse’s aides. That’s not easy to watch.
His once brilliant mind helped determine the best ways to isolate plutonium in 1944. He then spent decades studying photosynthesis and chlorophyll. Now his brain is somewhere else.
It started a few years ago. As Alzheimer’s disease progressed and choked and tangled his neurons, he started to lose himself and his encyclopedic knowledge, his sense of humor, his irritability, his warmth, his fearfully bad temper.
At first, he could tell that something ominous was happening. But there’s no way to stop it. Every time you see him, his decline is appalling. He stops recognizing his offspring.
He thinks strangers are in his apartment. Who are those strange people? No matter how often he is reminded that they’re his children, he feels threatened.
For a while, you’re convinced that you can somehow jog his memory. Maybe a photo.
Some incontrovertible proof that you are his, and that he will understand in a burst of rationality. Then, you finally realize that he’s disappearing, going somewhere solitary and strange. After 95 years, he’s leaving and never coming back — but, he doesn’t know that. Does he?
Eventually, you avoid catching his eyes, fearful of how he may react. Or maybe you do not want to see the vacancy behind his gaze. Or the fear.
He is relocated to the floor with the demented people. He has two broken hips made of tenuous bone too thin to repair. Two broken ribs. They’ll never heal.
"Dr. Browner," whom you never see, is convinced against all evidence that he is improving. He’ll be fine in no time! Of course, he can recognize food!
No, he won’t. No, he can’t.
You want to find Dr. Browner to ask him what he’s thinking and perhaps grab and shake him by the collar. What’s his plan? He gives nurses orders and vanishes.
Meanwhile, the patient is weaker, weaker and increasingly unhappy. He moans. Can he please be made more comfortable? Just ease the pain. That’s all the family wants. They plead. They cry.
The head nurse and the floor nurses, who dispense morphine, are following contradictory orders from the invisible doctor and the hospice nurse.
In books, the person with power of attorney handles the Browners and nurses with a firm hand. No one has a firm hand now. But you help to straighten out the heartbreaking mess.
Soon, much sooner than you expect, he’s gone. Dead.
No, this was not smooth.
Did you relieve his suffering or help kill him?
His clothes still hang in the closet. He still has aftershave in the medicine cabinet. His ornate letter opener is on his desk, where he left it. The books he wrote and read wait, leaning on the shelf.
Did you allow him to die in peace, or just hasten his death?
You’ll have the rest of your life to think about it.

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