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.