Thursday, 20 May 2010

The End?

How do we decide when the time is right for us to go? Can you imagine making the rational decision that now was the moment for it, now was the time for your life to end? With all the current controversy over euthanasia, mercy killings and the right to die, I thought I'd looked at end of life decisions from every angle, but in truth I've never really been able to imagine the reality of what it must be like to make that call. This week I saw it.

It started with a telephone call from a lovely elderly couple who were requesting a home visit. Mr Jenkins' belly had swollen up dramatically over the course of 2 days and they were getting worried. "He wont to go to hospital" were amongst the first words from Mrs Jenkins' mouth, "but perhaps there is something that you can do?"

I don't know this couple well, but there is something about them that I find inspiring. Mr Jenkins has been immobile since a stroke 5 years ago and as a result, relies very heavily on his wife. She too, however, relies heavily on him, and the strength of their relationship is palpable. They are always kind, respectful of each other's needs and above all incredibly loving. They are a pleasure to visit, and treat me like their long lost daughter when I do.

Today, however, I could see that they were frightened. They knew a little of what might be going on, as this wasn't the first time that this had happened. The explanation behind Mr Jenkins' massive abdomen was that his bowel had become obstructed and air was now filling the bowel like a balloon behind the blockage.

They loathed hospital. The waiting around, the not knowing, the helplessness. They asked me if his condition was life threatening, I told them it was. With tears beginning to fall, he looked at his wife and asked to stay where he was.

I found it hard to witness the emotional exchange that followed, feeling as if I was intruding on this grief-stricken couple whist they made the most agonising of decisions. If he stayed at home he was choosing to die, we all knew it. It was upsetting and yet, despite my awkwardness, I did get a sense of how privileged I was to be there with them.

I think he had made his decision, but his wife had not, and I could feel her agony as she sat down, head in hands. They wanted my advice and, feeling as if I was betraying him, I told them that my advice was to get him to hospital. The truth is, that whilst I knew he was desperate to stay at home and knew that there was a good chance he might not return from hospital if he were to go, I just couldn't let him stay. Bowel obstruction can be a particularly distressing way to go and I didn't want them to go through it. It was their choice of course, but I knew I was influencing their decision.

The ambulance came, took him to A&E and he's now on a surgical ward feeling helpless and miserable, just as he knew he would. He is alive, and his wife was brimming with gratitude when I spoke to her on the phone, but I wonder if he is so thankful? Should I have kept quiet and done whatever it took to follow his wishes, even if I thought he was making a mistake? Was I acting in his wife's best interests and not his? Was I acting in mine?

1 comment:

  1. Difficult, isn't it? My mother died recently in hospital. (She had cancer in her liver and brain.) At the point in time at which she stopped eating, nobody pressured her to do so and nobody put a feeding tube in. Everyone simply accepted that she wasn't going to go on fighting. Likewise, when she stopped drinking, we didn't force it. I think often people know when the time has come and it can be unkind to prolong their life.