Life can change on a dime

I am in the air again, flying to see my mother.

But this time, it’s because she is in the ICU.

My brother called me Sunday night and told me that she was admitted to the hospital because of breathing problems. She had another heart attack, developed pneumonia, and is now on a ventilator. My brother is already there, waiting for me.

One week earlier, our entire extended family was in Florida spending a week at a beach house. My mother sat on the beach, watching her three great grandchildren play in the sand; her adult grandchildren care for them, and her children soaking up the Florida sun. She was in the bosom of her family, absorbing our love and attention. She was in bliss.

But now she is on a hospital bed, with a breathing tube in her lungs, holding on to life. It’s true. Everything can change on a dime. We are wondering if she is coming to the natural end of her life. Or will she squeeze out a few more drops of time? At 91 years of age, it’s anyone’s guess.

My mother has prepared us well for this moment. She has made it very clear what decisions we should make in such a situation. My oldest brother is her “Health Care Proxy”—she has deputized him to make health care decisions for her if she is unable to. This is now the case.

Fortunately, my brother and I work well together. We had a similar experience when our Dad came to the end of his life. We both understand and respect our mother’s wishes. She is a very old woman who has lived a full life. She is not afraid of dying. While we don’t want to lose her, we recognize the inevitability of life’s end. We are not afraid to follow her wishes.

She only wants life sustaining care (ventilator, feeding tube, etc.) if it will return her to a reasonable quality of life. But what does that mean? In practice, in real time, these kinds of decisions are often difficult to make. What should we do, if after she is weaned from the ventilator, she goes into respiratory distress? Do we allow the doctors to put her back on life support? Or do we let her go?

What if her heart stops? Do we allow the doctors to resuscitate her? Or does my brother sign a “Do Not Resuscitate” (DNR) order? These are the practical decisions that family members must make.

We both know that every hour on the ventilator will weaken her ability to breathe on her own. We are fortunate too. My brother’s daughter is an emergency room physician and communicates directly with my mom’s physicians. My close friend is a retired ICU doctor who knows this landscape intimately. He is able to tell us what may transpire.

The clock is ticking.

It’s very important for families to discuss these matters with each other. I recently designated my youngest daughter as my “Health Care Proxy.” In addition to completing the form, I talked with her about my wishes and discussed a variety of scenarios. We had an open and frank discussion about my beliefs about end of life care and what I want. I have total confidence that whatever happens, she will make sound decisions. And, I know that she and her sister, like my brother and I, will work together well.

Check out the National Institute’s of Aging website on end of life planning. It can help you navigate some of these challenging issues.

Don’t put it off. Remember, life can change on a dime.

Share some of your family’s end of life experiences. What went well? What would you have liked to be different?