Saturday, February 13, 2010

On the occasion of my mother's birthday

Today Frances would be 91 years old. She's been on my mind, and this story forced its way out of me.

No Easy Way Out

“Margaret, your mother called and she’s lost. She’s in a very dangerous part of town. You need to go get her.” There’s a moment when you face it, the realization that your parents will not live forever. For me, it was the phone call. This woman who had found her way into the city for thirty years to visit me had taken a wrong turn, and I could no longer ignore the signs of dementia. In that moment parent and child roles reversed. She needed a caretaker, and I was it.

I’m not unique in facing the issues of aging parents. I’m in the sandwich generation, baby boomers with aging parents, asking Dad to stop driving and Mom to move out of her house. Other cultures live with many generations under one roof, where caretaking of the parents is a natural progression. But in my world, our parents live independently until they face their failing abilities. And we must balance our instincts to protect them with maintaining their quality of life, which most often they define as aging in place.

Nothing was harder for me than the beginning. I didn’t want the job of caretaker. I would rather have continued my comfortable life, work centered and self absorbed. I didn’t want to spend my weekends driving to my hometown to check on Mom. So, I ignored the signs.

Among the first signs was her oblivion that she might have cardiac issues. I accidentally uncovered the problem when I took her to a wedding anniversary party, and she became winded and unable to continue a dance. Mother’s reaction was that she had already lived longer than any of her family. Longer than her father, her mother, her brother. She was content with 80 years, and I was not to worry about it. The next day when it happened again, I made the cardiologist appointment.

Of course the diagnosis was blocked arteries. I knew it would be. But then came the second-guessing on the cure. What was I thinking, considering surgery for an 80-year-old woman? She could die in the operating room. If she lived, what was ahead? She already showed signs of dementia, with an average life expectancy as an Alzheimer’s patient of eight years. I could see the future: mental deterioration and death, and likely a death more gruesome than cardiac arrest. And then there was my own moral conflict. A heart attack was such an easy out from something I didn’t want to face.

Objectively, though, she still enjoyed quality of life. She still lived alone and she was still physically strong. Shouldn’t I let her make the call?

I stepped back from playing God and asked Mother to decide, and she chose more of life, whatever it might bring. It was not an easy surgery, not an easy recovery, and certainly not a life-changing event that motivated her to change her diet and exercise more. But because she chose life, she saw her two great-grandchildren born, the second one on her 84th birthday.

Still, years later, I ponder the question of end of life interventions. Does a physician make a recommendation based on the cure without answering the question, “Should we do this?” Does he have an ethical choice? Is the answer easier when it is covered by insurance? Because we don’t pay the bill, we don’t ask. We’ll haggle over the price of cell phone service and never comparison shop our medical care. If my mother had been given a choice between a surgery that cost $50,000 and reallocating those funds for scholarships for her great-grandchildren, what would she have said? Should we replace one heart valve or feed 5000 hungry people?

The more I ponder, the more I hope never to make such a decision again. Who really knows what lies ahead? What mortal would we trust to make those quality of life judgment calls? In the end, I think when we choose life, we make the only choice we can.

No comments: