Monday, December 26, 2016
First, Dispense of False Uncertainty
Your father is dying. I'm sorry. I know this sucks. It is horrible, and unfair, and heartbreaking. I have been there with my own loved ones and counseled many patients through similar situations. Your brain will try to convince you that it isn't so. That cure is around the corner, or that if you just make the right decision everything will be OK.
Everything will not be OK. Your father has cancer laced through his bones and inner organs. He is bound to his bed and can no longer feed or bath himself. He has lost interest in eating. Although I wholeheartedly regret this, I must not mince my words here. My bluntness is not meant to be unkind or crude. It is crucial that you understand where we are in order to move forward.
Death is coming no matter how much you or I wish to deny.
So let's not.
Indecision is decisive.
There will be a strong inclination to pause. These are horrid decisions that no family member should have to make. Yet doing nothing creates its own set of consequences. Without actionable breakers, our medical systems can become a runaway train of horrors. CPR will break your fathers ribs but will not remove the invaders overtaking his internal organs. Feeding tubes and IVs will deliver nutrients, but those nutrients will more likely feed the raving beast, and less likely provide meaningful benefit to his ailing body.
Ventilators are magical and awe inspiring when they support the respiratory system of someone who will eventually recover, and conversely barbaric when they provide buoyancy to an otherwise porous ship.
You should sign your father's DNR form. Life support will not save him, it will prolong his death.
Dignity turns process into an event.
In my interactions with your father, he has seemed a dignified and kind man. My wish is to provide as much dignity in death as he has enjoyed in life. To do this, we must move away from futility. Futile medical treatment brings pain and discomfort. Pain and discomfort turn death into a process. A prolonged, agonizing, distressing process.
I would like, instead, to think of his life as the process and death as an event. By treating him with dignity, managing his symptoms, avoiding unnecessary medical treatments, and providing joy in whatever ever mode possible-we can truly help him feel like he is living until the unfortunate moment he dies.
Bring it home.
I want you to know that I not only worry about your father's wellbeing, but also your own. After his death, despite your best intentions, you will spend much time thinking about his last days. Let's create a safe and peaceful landing place for him.
I hope to leave you with the memory that at this most difficult and important time of your father's life, you provided him selfless dignity and comfort.
You gave him one last gift.
You will sleep better during those future restless nights knowing this.
Posted by Jordan Grumet at 5:08 PM