What if he'd had no advocates?

Florence M. Weekes

March 04, 1993|By Florence M. Weekes

ALL his life, Karl had to fight for everything he got. Then they made him fight to die. It wasn't fair.

"He wants them to stop the oxygen and intravenous," his cousin Ann told me in an agitated voice when I arrived at the hospital to visit. "Please help. We don't know what to do."

I didn't know what to do, either. Ann and Karl were elderly, the last of their family in our area. He was terminally ill.

Karl hated being dependent. He hated hospitals and nursing homes. What he loved was his farm. There, he had once been young and vigorous -- and king. He had run 200 head of registered dairy cattle, knowing every beast by name, even recognizing their calves.

Then came illness. In constant torment and with lungs failing, Karl dropped first one chore and then another. Finally, he let the buyers take his cattle.

They took his spirit with them.

Not long after they hauled off his lifework, they hauled off Karl, too. They put him to bed in a nursing home, fastened him to a respirator for oxygen and fed him headache pills that didn't touch the pain.

He was in and out of the hospital. This trip, they said if he cooperated he might get well enough to go back to the nursing home again. He wasn't interested.

They strapped him to bed anyway, and tilted the whole thing until he was almost standing on his head. Then they pummeled his chest. He screamed in pain and protest. Next day, he gasped out his ultimatum. He wanted no more treatment to prolong what these people seemed to think was "life." All he wanted was enough sedation to stay out of pain.

"Do you know what will happen?" his physician, Dr. Thomas, asked. Karl nodded.

"I'll starve to death!"

They warned him it would take about five days. It took two. The unfair part was that they tried to stretch it out to five and even cut off his sedation.

That first day, Dr. Thomas ordered a stop to all special treatment except for methadone every four hours. Then he left. Karl just said he hoped they'd come soon with the pain killer.

Within minutes, a young nurse bustled in -- without any medicine -- banged down the bedside railing and started trying to drag Karl's frail body across to a stretcher. Since he refused their offered care, she said crossly, he couldn't take up a bed in that particular room. Ann and I chased her out.

Eventually the needle came and the matter of beds was resolved. That day and the next passed. Sedated, Karl assured us he was in no pain. He would take nothing but a few sips of water.

Next morning, Ann and I arrived to find Karl in terrified agony. He had been 16 hours without a sedative.

Summoned, a nurse strapped an oxygen mask on Karl and injected some methadone, which, too little and too late, did no good. Asked if he wanted the oxygen, Karl shook his head. He looked close to tears.

We discovered that a young physician, Dr. Breck, had changed the orders. He was even giving Karl extra medicine to "help" keep him going. Dr. Thomas arrived, and I launched a protest.

"Karl made a bargain with us," I said. "He's keeping his part; we should keep ours. What he's asking you to do might not be easy, but what he is doing is infinitely harder. He promised to die without complaining. You promised to keep him out of pain."

Puzzled, Dr. Thomas turned to Dr. Breck, who said he thought Karl should have a sedative only if he needed it and asked for it.

"He's too weak to ask or even make that decision," I said. "He tried to look after all that while he was still able. Now we are supposed to carry through his wishes for him, not ignore them just because he can't fight back any more."

Quickly, Dr. Thomas instructed them to bring more methadone and to stop other treatment as originally ordered. Karl lay quietly again to wait for death. It came within hours.

We heard the tell-tale rattle in his throat and Ann hurried for the nurse. I took Karl's hand, and it was as if some Other reached out and took it from me to lead the old man away. The shallow, labored breathing stopped. The blue drained from the vein patterns of the still face. Karl was gone.

But what if he had had no advocates to speak for him? What if those in control couldn't bring themselves to agree to his voluntary leaving? How long, and how awful, would his dying have been?

Florence M. Weekes writes from Victoria, British Columbia.

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