Like a hot potato being tossed from one player to the next, Leonard went from his primary doctor to an ENT specialist and finally to the emergency department due to a tumor obstructing his airway. Sophie, his daughter, stated, ”He needs one of those tubes in his neck that will allow him to breathe.” At 93, the emergency doctor took offense at the idea of Leonard’s needing to do anything without thoughtful consideration and Sophie’s oversight.
The cancer removed from Leonard’s vocal cord nearly 60 years ago had returned with a vengeance. Leonard was slowly suffocating and needed help. He was oxygenating adequately, but for how long? After placing the tracheostomy tube and obtaining a biopsy of the tumor, what’s next? A feeding tube, surgery, radiation and chemotherapy were all on Leonard’s to-do list. Did Sophie wish to see her father go through this ordeal? Did Leonard truly understand what he “needed” to do?
The prospect of death is frightening, yet prolonging the inevitable creates suffering. The emergency doctor posed this unthinkable question to Sophie, “Is it better for Leonard to suffocate or starve to death with this cancer literally choking the life out of him?” The doctor had to think twice about his own answer to this daunting choice. Three minutes without air vs. three weeks without food are the rules for survival. Was one of these choices better than the other? Sedation works wonders for respiratory distress, while there little comfort in starving to death.
Leonard had an advance directive and did not wish to be resuscitated if his heart stopped. Was everything to be done to keep him well-oxygenated and his heart beating until it stops? The hopeful answer is “Yes,” while the fearless answer is “No.” The emergency physician was almost merciless in his intention to have Sophie say “Yes” or “No” to her father’s need to proceed with having the procedure.
People are often quick to fault doctors for not explaining procedures, omitting alternatives or for permitting death. As a caregiver, Sophie got more than she bargained for with this doctor. Imagine being put on the spot and called to be either a fearless or hopeful. While Leonard had the actual medical problem, Sophie faced the moral dilemma of choosing between quality of life and quality of death for her father.
Explaining fearless as opposed to hopeful provides insight into this moral dilemma/medical decision process:
Hopeful = Vulnerable, meaning you rely on a higher authority to remedy the problem.
Fearless = Resilient, implying the right answer comes from one’s own inner strength.
Which word gives Sophie more certainty and Leonard more dignity?
The difficulty with being hopeful is that you’re prone to becoming mindless. All rational thinking stops and fear takes over the medical decision process.
The prospect of being fearless lends itself to becoming mindful/respectful. Spiritual wisdom overrules hope (expectation) and guides the medial decision process.
The emergency physician encourage Sophie to be fearless, but Sophie continued to hope that she wouldn’t need to weigh in on this medical decision. She remained hopeful and compliant with the ENT doctor’s recommendation.
What steps might Sophie have taken to reimagine herself as fearless?
- Engage the heart
Spiritual wisdom exists within the heart. Life begins and ends through your spirit which drives the first heartbeat and permits the last heartbeat. Caregivers can better help loved ones near the end of life through fearlessly enrolling their hearts in the medical decision process. Your heart has the inherent wisdom to know which choice is in the best interest of your loved ones.
Sophie relied on hope to stick to the ENT surgeon’s plan.
- Find Purpose
The main purpose of life is to create harmony and peace en route to the final destiny. Peace exists through the practice of nonviolence and stillness. This challenges caregivers to reduce stress and move past emotional unrest that often sabotages patients’ wellbeing. Purposeful/peaceful caregivers are supportive of and letting things be rather than attempting to fix their loved ones.
Sophie forgot her purpose by becoming distracted by hope
- Make the Ultimate Sacrifice
Recall: When the going gets tough, the courageous make the ultimate sacrifice and surrender. Letting go and saying goodbye through allowing nature to take its course is heart-wrenching. But caregiving is not complete without hardship and heartache. It’s not a job for the fearful and fainthearted. When push comes to shove at the end of life, will you be able to fall on the sword for the dignity of a loved one?
Sophie used hope to “die another day.”
When charged with making a life-and-death decision for a loved one, what’s your bet – to be hopeful or fearless caregiver?