The Oppenheimer Report 8/5/13

A few weeks ago I mentioned a patient I’d met on the stroke ward named Betty. She is 88 years old. When I first met her she’d had what I think was her eighth stroke. Most of those strokes affected her eyesight, but left her otherwise relatively intact. I’d see her walking around the ward with her IV pole and occasionally I’d walk with her and chat. She’s a tall lanky woman, and I joked with her that she was a marathon walker. She’s very intelligent, and she didn’t seem to be put off by my oftentimes inappropriate humor. I have met a lot of humorless people in this hospital, so when I find a patient with a keen sense of humor, I tend to glom on. Last week, Shauna mentioned that Betty had been acting strangely, and was sitting in a chair blocking the entrance to her room, with her back to the hall. Later I went in to ask her how she was doing, and it became immediately apparent that she’s had another stroke, this time a bad one. Her speech was noticeably slurred and her coordination was off considerably. Most notably, she looked and acted dispirited.

Though we were not close, I thought she might want to talk about what had happened, and she seemed relieved to speak frankly about her situation. She has had visitors, mostly friends, who I think are not particularly interested in dealing with the reality of her situation. I’m no shrink, in fact I could probably use one right now, but this woman needed to vent and I was available to listen. She was clearly depressed and said she wished the next stroke would take her out. She hated the uncertainty, knowing that more strokes were imminent and that she would never resume anything resembling her life of three weeks ago. She felt as if she was simply waiting to die. We spoke for a long time, and because I have spent so much time watching people die of late, for some reason I felt particularly suited to offer my unschooled opinions on the subject. There are not a lot of people I know who will speak frankly about death, or quality of life issues, but with this stranger, who was facing her imminent or perhaps not so imminent demise, I began to discuss Dad Taylor and his situation. I think the act of getting it out in the open, not deciding anything, not coming to any conclusions, but still revealing the dark feelings, was cathartic for Betty, and perhaps for me as well. It was a conversation I had with my father, and one that I wished I could have had with my mother. Most people don’t want to talk about it, but living in denial worse. Taking stock of one’s life, no matter how compromised it becomes, and being truthful with yourself can be life-affirming. As I have said before I am not at all religious, but I have evolved into a more thankful person than I used to be. I enjoy searching for and finding the honesty that exists in all of us. If more people would get their noses out of their Blackberries, Droids, and IPhones perhaps we could once again develop a sense of community, something I think has been on injured reserve for a long, long time. There ends my self-righteous rant du jour.

Another roller coaster week of emotions for the Taylor family. Having met with the hospital ethicist and having heard all the opinions for Syd’s chances of a “meaningful” recovery, Shauna and her mom had conceded that palliative care was likely the imminent next course of action. That meant no feeding tube, no IV, and only comfort care to ensure Dad Taylor did not suffer as he drifted off peacefully. As fate would have it, the night of that meeting, he rallied significantly, creating legitimate doubt about pulling his IV. He is clearly communicating in a meaningful way, for the first time, and even I the skeptic want to buy him enough time to make his needs known, if he can. This is more complicated than I could possibly explain on paper. Weighing the risk of complications against the hopes that he can say goodbye; these are not easy decisions. We will certainly not let him suffer – there is no indication he is now suffering now, and his vitals are better than ever – but despite the hospital’s glaringly obvious inclination to free up a bed, I’m not convinced he’s quite ready yet. Denial? Probably a little bit. Hope? By its very nature hope it is beyond what we know. But there is powerful love in the Taylor family, and I accept the decisions that have been made, even when I do not fully understand them.

I went to look for Betty last night and she has been moved off the ward and into a rehabilitation facility off site. I wanted to show her a B. Kliban cartoon about which a friend reminded me the other day. The cartoon is of a woman staring at two empty boots with smoke coming out of them. The caption reads: “Due to a convergence of forces beyond his comprehension, Salvatore Quanucci was squirted out of the universe like a watermelon seed and never heard from again.”

We should all be so lucky.

Written by Jamie Oppenheimer c2013 ALL RIGHTS RESERVED