Palliative Care And Prolonging Life: Have You Thought About Your Final Wishes?

April 1, 2015  |  

This is going to sound weird but for some reason I really love those Colonial Penn-type life insurance commercials that feature parents talking to their kids about insurance policies and death and end-of-life wishes because they’re so real. I especially like the one with the Black girl who has the curly TWA and keeps telling her mom, “I don’t want to talk about this” as she tries to explain her plans for making sure her death isn’t a burden on the family when the time comes. Eventually, there’s a breakthrough and the daughter realizes the conversation is just precautionary planing rather than foreshadowing and I always think, if only more mothers, fathers, daughters, sons, husbands, and wives would have these talks.

This past weekend I found myself in the unfortunate situation of watching my grandfather and my dad and his three brothers attempt to decide the fate of my grandmother’s life. The Saturday before last she collapsed and went into cardiac arrest and, due to a lack of oxygen, now has very little brain activity outside of basic reflexes to pain stimuli and gagging on a ventilator. By the time I got in town, seven days had passed and her status hadn’t changed, which wasn’t necessarily good or bad. But be that as it may, it was time to make a decision. And though everyone had an opinion on what they would want for themselves and what they thought my grandmother would want, no one really knew because no one ever asked or had a conversation.

“She talked about wanting to go home” was all my grandmother’s brother had to offer in terms of last wishes and we all knew that meant she wanted to be buried back down south. That really didn’t answer the question that was trying to be decided in the moment which was, do we do everything we can to prolong her life — despite the dismal prognosis and the expectation of an even lower quality of life — or do we usher her on to rest in peace?

We had the medical opinion which told us that the likelihood of recovery after three days in a coma was slim, but that was juxtaposed with guilt over the fact that my grandmother was in this position to begin with and mounting grief over the thought that the last time each of us had with her pre-ICU would in fact be our last time together. And so, opinions continued to sway back and forth for days.

“Guess we’ll just have to wait and see” was the decision my grandfather announced when the doctor hesitantly told us it was possible — though not likely — my grandmother could wake up one day. And so the doctors moved forward with a tracheostomy to remove the ventilator that’s breathing for her and inserted a feeding tube to give her nutrients while my dad and I toured long-term acute care facilities for her to reside in after her procedure for the next three weeks to a month. Though the plan we’re currently operating under is at least some form of action, it likely doesn’t change the fact that a month from now we’ll all probably be in the same place: Deciding life or death for someone who should’ve decided for herself.

When I came back to my mom’s house and updated her on what’s going on, she told me in no uncertain terms she wouldn’t want to be in that condition, which gave me the answer that I need if, God forbid, I find myself in this same position with her. Hypocrite that I am, I didn’t share my wishes, mostly because despite all that I’ve witnessed I’m not totally certain what they are. At my age, I think I’d want my family to fight for me. But if my quality of life — namely my independence — would be strongly diminished, I’d lean more toward letting me go. Of course, all of these things are easier said than done but they are certainly worth some thought at any age or stage of life and, most importantly, absolutely worth sharing with those who will be faced with seeing to your care should the time come.

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