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Final Acts, Last Rights

Final Acts, Last Rights

The ungainly process of dying under the influence of the medical profession.

Barbara Sumner Burstyn

We’re in the ambulance and the medic is asking my elderly mother-in-law a set Feel free to
contact me... I'm interested to hear what you think...
Barb. of simple questions; her name and age, the day of the week, the season and the year. When she’s unable to answer he glances round and then inquires; who is that woman with you? She looks at me from a great distance and I can see the effort it takes her to remember. Finaly she whispers, ‘my friend, my daughter’ and then stares at me as if I am a stranger.

By the time we reach the hospital and complete the marathon of examinations and assessments it’s 24 hours later and her list of mostly age related illnesses have coalesced into an all-encompassing infirmity. We watch her slipping further and it seems to us, the untrained family, that any hope of recovery is increasingly remote.

But we’re in the hospital and hospitals are hard-wired to do something, anything, to prolong life. As we huddle round her bed we want to discuss her options, her chances for a semblance of her former quality of life. But the doctors skillfully usher us back to the quantifiable, focusing on each of her ailments, identifying and untangling them and laying out the individual remedies as if she is no more than the sum total of her illnesses.

Next day we bring in her Living Will, the written testament of her fierce desire to live fully or not at all. No heroics, it says, no extreme life saving procedures. They nod and agree and suggest an intubation. Not a life saving measure at all they explain in modulated tones, but a simple procedure to enable the antibiotics to take effect.
Up against the white coated wall of knowledge we agree and they rush her away and return her hours later, a frail 85 year old woman, unconscious and slipping into an intensive cared state she will never awaken from. And almost without knowing we have signed away her last days to medicine, to the very things she’d been so adamantly opposed to.

Looking back it seems like medical slight of hand, a play on words, a semantic twist because once we are in their hands, once she is hooked up to their machines and dependent on them for her vital functions, one medical procedure leads inexorably to the next. And no one has the authority or the confidence to call a stop to it, ethically bound as they now are, to treat each of her symptoms as if it were disconnected from the whole of her person.

But it’s too late to object so we sit and listen as they explain her prognosis; dialysis, brain damage, liver damage and worse and no one mentions the obvious – that she has already died in every way except her entubated, beeping body. Her 94-year-old husband hears their drip-fed hope and after 61 years of marriage he clings to it in a daze. He’s a pragmatic man, a taciturn survivor of some of the worst atrocities of the 20th century and now he’s confused – a desperate old man who understands the absolutes of life and death but finds this suspended state beyond his comprehension.

And her living will? Her spoken desire to retain her dignity? The doctors look at us blankly, because separate from a legally executed Advance Directive or a Health Care Power of Attorney; her Living Will is useless. A simplistic platitude drawn up in times of good health that has no power when confronted with the legalities, complexities and specialties of medicine where no individual procedure can be called ‘life-saving’ but where combined they all add up to saving a life at any cost.

But at last, after eight days of gruelling bedside sojourns, the doctors admit defeat, their skills at warding off death finally exhausted, their science at an end.

And then they pass the baton.

It’s over to you now, they tell my father-in-law. He gazes at them blankly. This ultimate decision, a task beyond his coping. And as he sits beside her, his hands avoiding the tubes, his eyes begging her forgiveness he cries that they have made him her executioner.

And the doctors who have bought us to this moment?

Suddenly they are passive spectators, standing back with clean hands, watching as we act out our roles in the drama they have created.

Finally he makes the decision that can no longer be avoided, believing, despite all our assurances, that he has committed the gravest offence. The doctors swing into action and remove the devices they have filled her with. And we sit in the hushed bustle that is intensive care and wait for nature to take its course, until she shudders to her end, a fragile old lady accomplishing the final human act in a very inhuman place.

© Barbara Sumner Burstyn, April, 2002

P.O.V. with Barbara Sumner Burstyn @ http://www.spectator.co.nz/POV


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