Life, Death, and Other Matters of Consequence: Part I

With the advent of chill winds and falling leaves, it almost seems as if the world is in a hurry to finish its business before winter comes: animals grow thicker coats and store up food for the long, cold months; flowers fade and vines wither; humans stock their pantries in anticipation of the upcoming holidays. And all too often, the change of seasons heralds not only the end of the year, but the lives of the sick and old.

Letha* was a ninety-year-old, ninety-pound train wreck of a woman who arrived on my long-term care unit the day we turned the clocks forward last spring. She had previously been healthy and independent, but a series of strokes followed by medication-induced diabetes had robbed her of most of her sight, as well as her ability to walk, toilet herself, and perform most of her own ADLs. She was alert and cooperative, and she never complained, but with fingersticks and insulin coverage, plus two large decubiti, plus frequent urination, she required a lot of care.........just what we needed on a unit that was already overpopulated with IDDMs and wounds and LOLs with half-ounce sized bladders.

And then, there was Letha's family.

Letha had three daughters and a son, and the most polite way I could describe the daughters was 'intense'. These women were at the facility a minimum of 16 hours a day, endlessly fussing over Letha and demanding that we wait on her hand and foot whenever they were out of the building. Letha had a twenty-minute ritual for mouth care in the morning, and an equally involved routine at night. Letha needed to have her feet elevated just so whenever she was in bed. Letha may not drink any juice other than cranberry. Letha was not to wait more than two minutes for assistance after pushing the call light. Letha must get up for all meals, but be in bed for the night no later than 1930. Letha's 'needs' were so numerous, in fact, that they didn't fit on our one-page care plan form, so a PeeChee folder with the play-by-play was placed on her closet shelf for staff reference.

Well, as is usually the case with these situations, Letha herself was not the problem. Her sweet nature and cheerful outlook made her an instant favorite with other residents and staff alike, and despite some dementia, she had such a quick wit about her that we were always taken by surprise. One afternoon as I was checking her blood sugar, I was bemoaning the sad state of her fingers, all of which were so bruised and mangled from QID fingersticks that I almost couldn't bring myself to do the deed; instead of complaining, she quipped, "It'll hurt you worse than it does me, 'cause I'm gonna take a bite out of your arm before you do it."

Weeks, then months slipped by as Letha began to grow stronger with the help of our physical therapy team and the ubiquitous presence of her daughters, who continued to encourage/force their mother to do things she didn't want to do in order to achieve their goals for her (which, as many of us privately believed, included staying alive forever). For a while, it looked as if she might just walk again.....until she caught a bad cold that promptly turned into pneumonia. We administered antibiotics and breathing treatments every four hours round the clock until she was out of danger. She contracted C. difficile after this episode and landed in the hospital, then returned with several new medications added to the arsenal of drugs we had to crush and administer, one at a time, due to her dysphagia. She followed up with yet another mild CVA a couple of months later..........and in the meantime, more and more tasks were being added to her care plan by her ever-vigilant daughters, who spent much of their time complaining to management about what they called "the lousy care that's killing our mother".

Naturally, we nurses and aides resented the implication that our unwillingness to ignore our other 28 residents so we could tend to Letha every waking moment was "killing" her. As much as we loved her, there simply weren't enough hours in the shift to fulfill all her daughters' demands, and frankly, she was NINETY......and in bad shape to boot. What did they expect from us, anyhow? Miracles?

On a personal level, however, this went far deeper than simple annoyance with a fussy family. I have long been angered by our society's refusal to acknowledge death as a fact of life. I see it every day in the faces of elders whose bodies are still here, but whose minds and memories have long since deserted them........the pain-filled eyes of patients in the late stages of cancer...........the epic waste of limited resources on treatments that merely prolong the inevitable. And in many cases, they endure it all only because their families can't (or won't) let them go.

It was obvious that this series of downturns was a signal that Letha was getting tired, and we often talked among ourselves about how we wished her daughters would stop pushing, pushing, pushing and let Nature take its course.

~Continued~

*All names have been changed to protect the privacy of the individuals involved.

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About VivaLasViejas, ASN, RN

Long Term Care Columnist / Guide

I'm a Registered Nurse and writer who, in better times, has enjoyed a busy and varied career which includes stints as a Med/Surg floor nurse, a director of nursing, a nurse consultant, and an assistant administrator. And when I'm not working as a nurse, I'm writing about nursing right here at allnurses.com and putting together the chapters for a future book about---what else?---nursing.

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Life, Death, and Other Matters of Consequence: Part I

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