Secret Ballot

Families handle dying in such different ways. Our family hasn't had to deal with end of life decisions, so I can't say how we'd do it.  Throughout residency, these family meetings deciding the future of the life of a loved one, have been the most fascinating. The intense emotions, the passionate pleas... I wish I could have a sound recording of them.  This always occurs when there is conflict. It's the same thing every time- 80 something year old mom is in a coma, or has such severe Alzheimers she doesn't communicate anymore.  There are options to be aggressive and prolong life with medicines and machines- or we can let nature take its course.  Ultimately, there seems to always be arguments.  1 sister wants aggressive things, the other wants to let mom go. If only there were written living wills, or something. 

One patient's family this week had an unusual solution.  Their mother- in her 80's, has not been communicative for years.  She's got vitiligo- a condition that makes your skin white.  She's black- so her appearance is startling- like a calico cat- half white, half black - all in spots.  Her mouth is always open- giving her the appearance of a skeleton with it's jaw unhinged. Her eyes are never open. This poor woman needs to die. I can say that easily as a doctor. However, the family wants to keep her alive by any means- well, most of the family.  The arguments have been loud and noticeable by all in unit 43.  The eldest  daughter who's a preacher, is in charge.  She finally decided, enough arguing.  They got the whole family assembled 2 nights ago.  There were 35 people there!  They talked and gave arguments for their positions...and then... they took a secret ballot.  Honestly, they wrote down on pieces of paper wether they thought "mom" should live or die.  No raising hands- you'd be holding grudges with each other for years-  it was all secret.  And the tally-  she lives.

When you step back it's eerie- a secret ballot to decide her fate. Moral of the story-  make sure you know what your loved ones wish for near the end; or you may be the one scribbling "live" or "die" on a piece of paper someday.

Dementia

Have you ever wondered what it really must be like to loose your mind?  To open your eyes and look around, and it all be unfamiliar and new?  I was thinking about that today when we went to see one of our patients with Alzheimer’s. There she sat with her pearls around her neck, and a long gold chain medallion and locket adorning her hospital gown. She was looking at her 2 watches both on her left arm next to her ID bracelet. When we entered she said cheerfully, "I hope you can help me... it seems I don't remember where I'm at or how I got here, but I sure hope I can get home soon." I was surprised she was so up beat, even though she knew her mind was in trouble.  "I'm having a problem with my memory, I just can't understand things" she said, smiling, her glasses half way down her nose like a librarian. She had learned to be clever, adapting to her loss.  When asked "Do you know where you are?" She'd quip, "sure I do, I'm where you are" Is that the grace that accompanies the loss of awareness?  That you also don't know enough to be scared?  I'd think it terrifying, if tomorrow I woke up and didn't know where I was... nothing familiar- the walls, the bed, the people...my mind would whirl trying to recount the last possible memory I DID have.  If it searched and found nothing...what then? Panic? Despair? Yet how happy and childlike Ms. H was.  Unconcerned, if not a bit entertained by all of us.  Although in 5 minutes time, Ms. H will have forgotten me, I don't want to forget her, and her pleasant dementia.  Since I didn't have any camera, I decided to sketch her and those crazy pearls… not as art, but as a reminder.