“…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.)