When is Medical Intervention Too Much?

“…we have allowed our fates to be controlled by the imperatives of medicine, technology and strangers.”

Atul Gawande – Author of “Being Mortal”

For most of us, a referral to a medical or surgical specialist can be a lifesaver. But for my 91 year old mother with Alzheimer’s disease, there are always additional issues to be considered. Recently, her primary care doctor referred her to a urologist and he ordered further tests, including a CT scan. I was grateful because I thought it would give us some good information about her recurring infections.

But two weeks later, at her follow up appointment, he told us that my mother needed immediate surgery with the potential for additional alternative procedures, and I was forced to raise my hand to interject.

“My mom is not a candidate for surgery, I’m sorry. She is 90 years old, she has Alzheimer’s disease and I do not want her to have to go through that trauma.” The surgeon was not happy. He insisted that we had no other choice, and from his point of view, I could understand. But there is always another choice.

Symptom: Medical Advances Often Trump Common Sense

I have seen it over and over again. Families want to do everything possible to keep their loved one alive. They opt for every medical intervention offered not ever asking, “How will this affect their loved one’s quality of life for the time they have left?”

There is a medical specialty for every system of the body and every disease. Physicians offer the latest in treatments, medications and new technology…it is what they do.

Diagnosis: It Is Difficult to Let Go                        

So often there is a surgery, or one more new medication, or radiation that is offered to postpone the inevitable. We are made to think that there is no hope if we do not take one of these courses. And we don’t want to stand in the way, do we? We don’t want to be responsible for the death of a parent! I think we are never prepared for their death.

Treatment: Ask the Difficult Questions

Ask the doctor how it will affect your loved one’s quality of life. How long does the physician feel your parent has to live with and without the offered treatment or surgery? What are the chances for complications at this age? What are other options? One can even ask “If this was you, would you choose this treatment?” Statistics show that physicians often would not choose what they offer to their patients.

I knew the risks involved with the surgery being proposed. And I knew how uncomfortable Mom would be if they needed to perform the alternative procedure. It is very difficult for my mom to be in the hospital. With Alzheimer’s disease, she gets so confused and agitated when placed in a different environment. Even so, the surgeon tried to make me feel like we had no other choice.

But we did have another choice. We put my mom back on hospice and allowed the hospice team to manage her symptoms. That was 8 months ago and my mom has been comfortable and happy ever since.

(See previous blog, “Hospice is a Lifesaver” April 2013.)

10 thoughts on “When is Medical Intervention Too Much?

  1. I couldn’t agree more. It is a conversation I have had with Boni and Ryan. Having had a stroke and cancer, I am very much in touch with my own mortality. Boni totally gets it. My son struggles. Ryan and I are so close that he will never be ready for me to go. The hardest thing he will ever have to say will be: “It’s OK dad. I love you. You can go now, it’s alright.” Because for him it will never be alright. I was able to get there pretty easily with my dad. It was harder but I even got there with my mom. But part of that acceptance comes from our shared faith. Ryan and I don’t share that. It is going to be very hard on him and difficult for me if he is where he is now. We already talked about the Tamoxifen. He understands that I want to stop he really doesn’t get the why. The side effects to him don’t seem bad enough for me to quit and risk the 2 point increase in getting cancer. I will be teaching him a lot about quality of life from here on out. Great blog Jane. Seriously.

  2. This is so true, Jane. The decisions are sometimes easy and other times not at all. How much intervention is too much?

  3. I totally agree. I allowed too much intervention for mom and she was uncomfortable the whole 3 weeks from when she broke her hip till she went into hospice just a day before she died. In some states, like Florida, doctors are too quick to want to do more surgery on very elderly patients. Luckily here in the Northeast, they agreed with my request for hospice for dad and he died with love and family around and no extra unhelpful medical interventions. I am glad you made a choice you both could more easily live with!

  4. Great blog, Jane! Having been by the side of more than a few close family/friends going through terminal illnesses, I have witnessed the panic and tunnel vision that occurs when a loved one is dying, and all those around them can think of is buying more time, no matter what the cost. We must keep quality of life in mind, and not run on automatic. The good and faithful doctors who serve us are doing what they committed to do…keep us alive; but we have to be responsible for stepping back and viewing the larger picture. I love that Mom is happy and comfortable, for whatever time she has left. God bless you for all you do for your folks, and for us in sharing your experience.

  5. Thanks for saying, Jane, what needs to be said. When you are 90 it’s all about quality of life rather than quantity. Blessings as you minister to us all.

  6. Well said Jane – you say the hard things with such compassion. And the things you said here can be applied to so many different situations we navigate in life.

  7. It is refreshing to read a balanced view about treatment for a elderly parent or other aged family member. Taking a different path than what a Surgeon or other Physician says can cause guilt and a feeling of helplessness, for not trying to “cure” an affliction of old age. Old age cannot be cured. Thank you Jane for reminding us it is a time for comfort and love. The stress of a surgery, of being in an environment that’s confusing and causes fear in not what aging is about. There are times when treatment may be an option, but not until all aspects of the elderly persons being are brought to mind.
    I graduated from Nursing school 40 years ago, bright eyed, full of new knowledge and ready to “save” every patient I touched. Now, 40 years down the line and reality and compassion bring new vision. It goes without saying,not to hasten death, but many times treatment means comfort, pain treatment, and Love. To accept that only God knows when it’s time. And our part is to pray, love and cherish the time our loved one has!

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