Death with dignity

They leave the old man wrapped in a blanket. The rest of his people move on after saying their good-byes. A blizzard consumes the prairie and covers his body. At least that was the movie’s portrayal of the fate of the Lakota aged, those unable to keep up with the people’s nomadic lifestyle.
Jimmy Stewart, I don’t remember the character he played, or who played his wife. I do remember that rather than be consigned to a nursing home, they go into their garage, get in their car and start the ignition, drifting off into a carbon monoxide induced death.
Both of these scenes remain in my mind thirty some odd years later when faced with the dilemma of an 88-year-old mother consigned to a nursing home. She watched those movies with me, always with tears in her eyes, always with admonitions against those who would consign their parents to such a fate. I was being groomed to make sure it did not happen to her, but in spite of all our efforts to the contrary it did.
It was the day before summer break. I had not quite finished my 45 mile commute to the high school where I teach, when I received the call that Mom had fallen and could not get up. She had been living between my sister and myself for the past four years when a series of mini-strokes had made it impossible for her to keep living at home in her small South Dakota town, 40 miles from the nearest clinic, 100 miles from the nearest hospital.
So, for four years, she made the rounds between where I lived in Reno, Nevada and where my sister lived in Riverton, Utah. Every 8 to 10 weeks we would do the “Mom” exchange, meeting in Elko (the half-way point) to have lunch and trade off on “Mom duty.”
Over those four years, she seemed content to sit on the couch reading, waiting for us to return from work to cook supper and have a bit of conversation before she retired for the evening. The dogs were her day-time companions, and although bound to a wheel-chair she was able to wheel her way around the house and make her way to the toilet when needed. For showers she needed assistance, so shower day was Sunday. Because coumadin had been prescribed, she also required monthly visits to the lab to test her blood and make sure her blood levels were where they needed to be. Sick days could be taken from work to make these visits, or appointments could be made late in the day, and for four years, we kept the idea of a nursing home at bay, and then she fell and broke her hip.
Hospitals rarely keep anyone for longer than a week these days, and an 88-year-old with a broken hip is no exception. We went with her into surgery that night at around 11:00 p.m. and were there when she came out shortly thereafter. Assured that everything had gone well, we went home to sleep, arriving back at the hospital early the next morning for an almost instant decision making process.
Rehabilitation hospitals and nursing care facilities vie to have Medicare patients instated in their place of care, at least for the first three weeks. For those three weeks Medicare pays a premium, and the facilities may actually make money. If the patient requires longer rehabilitation, the payment Medicare allows drops substantially, but they will keep paying for another 100 days, as long as the patient is “making progress” . After one hundred days, if the patient fails to keep improving, private pay (the patient’s own bank money) is tapped, and when that money runs out the State’s Medicaid program hopefully takes over.
At the time I was reading a book by Toni Morrison which made a comment about how western society files away their old in nursing homes and forgets about them, filing away their wisdom at the same time. Not too long ago I would have shaken my head in agreement, but when faced with the situation, I found myself getting angry… and defensive. Unless a person has the type of job that allows them to stay home and work, how are they able to take care of a parent who needs 24 hour care?
Luckily, unlike most Americans, I have a job that gives me three months off every summer, and when Mom fell the whole of that 80 days stretched in front of me. My goal was to have Mom back in her wheelchair, wheeling happily from room to room, hopefully stronger and in better shape than before she fell and broke her leg. After all, her mother, had broken her hip at 87 and had returned home within three weeks where she continued to live and take care of herself until she died at the age of 93.
Each day I went to the rehab center (that’s what it was before we realized rehabilitation wasn’t going to happen). For the first two weeks I went off and on for eight hours of every day, cutting that to six, then to four, and in the last few weeks before I had to return to work to two. I was exhausted, emotionally and physically, and Mom was not getting any better.
I had learned a whole lot about my fate, which at 50 seemed to loom just around the corner, and I didn’t like the look of it. Like most people, I had managed to convince myself that if I ate healthy, exercised daily, and scheduled in regular check-ups with my physician, somehow this infirm, old-age thing could be avoided. Mom had believed the same. She was no doubt one of the few mothers in South Dakota to make homemade Granola, buy carob powder, and purchase a multitude of vitamins from a supply catalog that arrived monthly.
In her late seventies she was still trekking to Pierre, South Dakota for the Senior Olympics, where she not only participated, but won medals. In her early 80’s she was still driving herself to book signings through-out the state to promote two books she had written and published about her life. Yet, here she was at 88 unable to walk on her own, getting weaker by the day in a place that was definitely not healthy for her. It did not appear; however, that there were a whole lot of options that were any better.
In agonizing over this situation with friends my age, all thought they would prefer to do what Jimmy Stewart did in the movie. I know though that death is a tricky creature and by the time he’s knocking at your door, you probably won’t be able to walk to the car, much less kneel down to stuff a rag up the tail pipe. Pills were another suggestions, but chances are you won’t be able to lift your hands to put them in your mouth and asking someone else to do this seems out of the question. The obvious solution would seem to be to make sure these places are more humane, or that there are more choices for people faced with this situation.
How to make this happen? I have no idea, but since my time may be right around the corner, I’d really like to hear some suggestions. Maybe it can be the torch I take into retirement.