Oct 23, 2013

Killing our Parents with “Kindness”

While my mother’s world, once so large and bright, had certainly been much reduced, we were proud of the fact that we had managed to honor our promise to her never to put her in a nursing home and that she was still able to continue living with dignity in her own home.

By Shira Sebban
 Alzheimer's Reading Room

Killing our Parents with “Kindness”  border=

“Who authorized this patient to be administered morphine?” The hospital geriatrician’s voice was stern as he addressed the staff clustered around my mother’s bed. “She’s for active care, not for palliative care – she’s going home!”


With the doctor finally on side, I felt like I had won a battle – the battle to stop the morphine, which the hospital staff had insisted on giving my mother periodically ever since she had been admitted three days earlier after choking during her birthday celebratory dinner at my home.

Afflicted with late stage Alzheimer’s disease, she was no longer able to communicate with words, and so the nurses and doctors had been interpreting her occasional mumbled utterances as signs of pain or discomfort.

Familiar with my mother’s behavior, however, I knew that this was her way of communicating and that she was not experiencing pain, and certainly not at the level of severity normally associated with the administration of morphine.

At first, we had accepted the morphine without question, being assured by the medical staff that it was only a low dose and would assist her breathing.

But when the dose continued and even increased, despite her oxygen intake having improved, doubts began to surface.

Couldn’t morphine decrease the respiratory rate in the elderly and even cause respiratory failure?

Wasn’t it used in palliative care situations both to ease pain and ultimately to hasten death?

Indeed, my father, afflicted with aggressive prostate cancer, had begun asking for morphine with our blessing the day before he died.

When I first met the geriatrician across my mother’s bed during his Emergency rounds, he had expressed shock that “she was still alive”.

Horrified, I assured him that she still had a good quality of life. “She doesn’t have any quality of life,” he pronounced. “She can’t go to the movies or see her friends.”

While my mother’s world, once so large and bright, had certainly been much reduced, we were proud of the fact that we had managed to honor our promise to her never to put her in a nursing home and that she was still able to continue living with dignity in her own home.

Furthermore, she still led a daily existence in which her care and wellbeing were paramount, going on outings with caregivers to local parks, attending an adult day care program twice a week, and joining our family for dinner every Friday night.

Above all, she absolutely loved her food, and as her world shrank inwards, eating became one of her few remaining pleasures. I made sure to buy her favorite dark chocolates, pastries and breads, as well as other delicacies that I thought she might enjoy, always remaining vigilant to the risk of choking by ensuring her food was chopped into tiny pieces and allowing plenty of time for meals.

This time, however, I had failed – she now had aspiration pneumonia – and the geriatrician, who had never met my mother or her family, had seemingly decided that her life was not worth saving.

I decided to take her home.

“If she goes home, she will die,” he replied. “If you want to save her, let her stay for a course of intravenous antibiotics.”

There was a catch – absolutely no food except for intravenous fluids until the speech pathologist had administered a swallowing test to determine her future diet.

It was Saturday afternoon and the speech pathologist did not work on weekends. By the Sunday evening, my mother had been moved to a ward and I went in to ensure she had not been written up for morphine. The night nurse assured me that she would note my concern that no further morphine be administered.

Yet.

The next morning when my sister arrived just before the all-important swallowing test, she found that yet another, even higher dose had been given half an hour earlier because “the patient had appeared restless”.

The speech pathologist arrived to find our mother asleep. No swallowing test would take place that day.

In the end, thanks to the geriatrician’s intervention, she was able to go home the next day, fully recovered from her bout of pneumonia.

Gone were the breads, cakes and adored chocolates – henceforth she was only allowed gelled bread that had been soaked in jelly until it became soggy and this prospect just seemed too awful – but we replaced them with mousse and custards and began to add thickeners to her now minced and moist food.

It was just not worth taking any further risks.

Our beloved mother passed away a month later from an unrelated condition.

But I can’t help wondering how many of our elderly and vulnerable parents are risking their lives when they enter hospital, with no one to champion their rights – except for us.

Shira Sebban is a writer and editor based in Sydney, Australia. A former journalist, Shira previously taught French and worked in publishing. She is also vice-president of the Board of her children’s school. You can read more of her work at shirasebban.blogspot.com

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