Tag Archives: Health

Reflections on Death & Dying – The Beginning of the End of SOB (Sweet Old Bill) – Part 2

In July and August 2013, I supported my uncle, William Leo Pence, as he died. It was my chance to be there for a family member I loved. It was also an opportunity to put into practice my beliefs about human dignity, choice, and the power to make our own decisions and have them respected at the end of life.  It was one of the most grueling things I’ve ever done.

Born November 19, 1928, my uncle was a veteran of the Korean War. He stood 6’6” tall and his personality matched his height. Eight years before his death, he’d had a kidney transplant, but aside from that, and low level medications for slightly elevated cholesterol and blood pressure, he was very healthy. He was bright, independent and active. And, as Frank Sinatra would say, he liked to do things his way.

Once he took himself off all his medications, including the anti-rejection drugs for his kidney, he thought he would die quickly and peacefully. He put his affairs in order and went home to wait. (If you are reading this blog for the first time, the introductory post to this story can be found here: https://dballardreisch.wordpress.com/2014/10/14/the-florence-journals-reflections-on-death-and-dying-the-beginning-of-the-end-sobs-story-sweet-old-bill/) Unfortunately, will is not always the same as outcome, and what my uncle thought would take days, took more than a month. During that time, he gave me his durable power of attorney and I became his health care surrogate. Technically, he shouldn’t have needed a health care surrogate. He had spelled everything out very clearly. His advanced directives were in order: No invasive measures. No lifesaving interventions or life extending treatments. He wanted to live as fully as possible for as long as he had. He just didn’t want anything to make that longer than it needed to be. He did want to continue speech, physical, and occupational therapy so that he could be independent as long as possible. He wanted to live the highest quality of life he could.

During this process, my uncle made a mistake that almost took choice out of his hands. It had been a long, trying day. He was tired. He was uncomfortable. He was bored. He was fed up. Taking himself off medications had not led to the quick, painless decline he had anticipated. He wanted to talk with someone he thought would understand what he was feeling, but who wasn’t personally invested in his situation. He called 911. He wanted to tell someone that would understand that he was ready to die.

My uncle lived in Florida and his admission to a health care professional that he was ready to die led to his emergency admission into the hospital under the Florida Mental Health Act of 1971, the Baker Act. The ambulance came to my uncle’s house, took him to the hospital, and kept him for the full 72 hours allowed by law. He was furious! Unbeknownst to him, in Florida, it is considered against the interests of the state for an individual to be ready to die. The powers that be see it as a small step from being “ready” to die to committing suicide. The Baker Act required that he be assessed by a psychiatrist to determine if he was potentially dangerous to himself, someone else, or whether he had a mental illness. The key question was whether he was a suicide risk. Had they seen him as suicidal, the doctors told me that would have overridden his advanced directives even if he had been considered sane when he made them.

At the hospital, he rallied and convinced the psychiatric staff that he was not suicidal. However, without consulting us, they put him on medications to stabilize his mood and treat what they saw as depression. Now that they were convinced that he was stable emotionally, the question became what to do with him. After the 72 hours, they had to commit him or release him. He could no longer walk unaided and had very little strength. His insurance didn’t cover 24 hour nursing care. His friends, who were in their 80s, couldn’t care for him now that he was largely immobile. I lived 1300 miles away. He couldn’t go home. The doctors told us that they could not send him to a rehabilitation hospital unless he showed them that he wanted to get better. Because his test results were still so good, they didn’t think his decline was steep enough to warrant hospice care. The idea that he wanted to be as healthy and capable as he could as long as he lived, yet refused to take medication was confusing for medical staff. After much discussion, his doctors decided to give him a physical therapy consultation which would determine whether or not he could be placed in a rehabilitation hospital. My uncle used every bit of strength he had and cooperated fully with the PT assessment. They found him compliant, cooperative, and committed to building his strength. They decided to send him to a rehabilitation facility. Now if was my job to find one.

The Florence Journals: Reflections on Death & Dying – The Beginning of the End of SOB (Sweet Old Bill)

On July 4, 2013, Bill declared his independence. In the early 2000s, he’d had a kidney transplant. Aside from that, he was an extremely healthy 84 year old. As with most older adults, in the United States, though, he was on multiple medications to manage multiple minor chronic issues. That’s really context for our story. Approximately a year and a half earlier, after his wife’s death, a series of minor mishaps, literally missteps, started the journey that would lead to his declaration. He needed to have several toes removed due to poor circulation, causing significant mobility issues. Recovering from this, he contracted a virus that put him to bed for several weeks. When he was well again, he was extremely weak and needed to build strength to walk again. He got to the point where he could use a walker or a cane to haul his 6 foot 6 inch frame around, and ultimately take several steps unaided. However, his strength and vigor did not return. This frustrated Bill, an extremely independent man.

One evening he stepped on something sharp. He couldn’t see or feel what it was, but his foot bled profusely. His neighbor and good friend Dino, who had been his support person, particularly with activities of daily living, would be over the next morning to assist him, so Bill just put on a Depends, wrapped his foot in a towel and went to bed. The following morning, Dino found him this way, blood soaked towel wrapped around his injured foot, soaked Depends, his friend needing assistance. Dino cleaned Bill up as best he could, washing him, slathering his foot with antibiotic ointment, and bandaging his foot. The bleeding had stopped by then. Dino made Bill breakfast. Bill, not being one to lie idly by, fussed and grumbled about not being able to get around, but Dino persuaded him to stay in bed that morning and give his foot a rest.

The next day, Bill was still in pain and couldn’t put weight on his foot; Dino cleaned and re-bandaged it for him. This happened the next day and the next and the next, until the fifth day when Bill awoke with a fever and Dino recognized that Bill’s foot was infected. Dino called an ambulance to take Bill to the hospital.

Whether the toe removal, the virus, the item Bill stepped on that led to the infection, or the spiral of medical issues set in motion at the hospital when Bill arrived for treatment for his foot were singularly or collectively the last straw, for those who knew him, Bill’s July 4 declaration of independence quickly became a predictable conclusion. Bill was a proud man, an independent man. He’d been in the medical corps during the Korean War. He was not comfortable relying on others.

At the hospital, an inexperienced physician disregarded the information that Bill had had a kidney transplant and prescribed an antibiotic that disrupted his kidney functioning. He told Bill he was sorry, but they would need to do minor surgery to repair the damage. Bill took matters into his own hands, requesting a psychiatric consultation. After a 45 minute consultation, Bill asked the psychiatrist if she thought he was competent to make his own medical decisions. She responded “Absolutely!  I have no questions at all about your competence. Why do you ask?” Bill replied, “Because as of today I am taking myself off all my medications. I am also refusing this surgery to repair the damage caused to my kidney by the antibiotics and I don’t want anyone to be able to challenge this decision. Now, please get a piece of paper, we’ll write out each of my medications. I will sign that I refuse to continue them and you will sign that I am competent to do so”. Surprised, the psychiatrist did as Bill requested.

Bill remained calm and resolute as several medical professionals tried to talk him out of this decision. He was done with medical care. With signed paper in hand and fresh advanced directives and against his doctor’s advice, Bill was wheeled out of the hospital. His trusty friend Dino was there to take him home. Bill believed that he would die quickly as he thought that taking himself off the anti-rejection medication for his kidney would lead to his body rejecting the kidney, causing it to shut down. He believed he would die quickly and painlessly. That was not to be the case.

When Bill left the hospital, he believed he was going home to die. His two friends Dino and Kenny disagreed with Bill’s decision and it took him several days to bring them around to at least understanding his way of thinking. Once they were grudgingly on board, Bill called me, his niece, and told me of his decision. I listened quietly. We both shed a few tears. I told him I loved him and would miss him, but that I would fight for his right to decide. Neither of us knew what this would ultimately involve. But our trust and commitment to one another, and to Bill’s right to make this decision, strengthened our resolve to face whatever came next.

Bill got his affairs in and went to bed to wait.

Conscious Uncoupling and Coparenting: Why Gwyneth Paltrow and Chris Martin Have it Right!

Full disclosure

I am a child of divorce. It was not pretty. It was not healthy. It was not done with grace. I felt I had to choose a parent. I couldn’t have both of them. My siblings and I were too little (6 years, 5 years, 4 years) to do more than go where we were told to go, when we were told to go there, but it was clear to me, early on, that being close to our noncustodial parent was a disloyalty to our custodial parent. My noncustodial parent was ostensibly out of my life by the time I was 8 years old.

I swore I would NEVER get divorced!

My husband was a child of divorce. It was not pretty. It was not healthy. It was not done with grace. The hurt lingered. I will not tell his story.

He swore he would NEVER get divorced.

We swore WE would NEVER get divorced.

We GOT divorced.

Our Conscious Uncoupling

In July, 1998, I broke my promise to myself, to my children, to my husband. When together my husband and I told our 9 year old son we were planning to divorce, he said “wow, I never saw that coming”. His words broke my heart. Our 4 year old daughter didn’t understand. She just wanted to be sure we would both still be her mommy and daddy. We reassured her as best we could.

I knew that I didn’t want the model of divorce I’d inherited to be my children’s experience. My husband and I decided our most important responsibility was to continue to parent our children and that they needed this separation to be as painless and smooth as possible.

We decided to forego attorneys and to do the divorce ourselves. We didn’t want an adversarial break. We wanted to collaborate, decide together what was best for our family. We read Nevada law, child support guidelines, reviewed model divorce decrees, got the Nevada do-it-yourself divorce guide, and set to work. Together my husband and I negotiated everything. We both wanted what was best for one another and for our children. After our divorce, we continued to live in the same house for over a year. For many years, we continued to celebrate holiday together.

So, what is my point?

No couple’s conscious uncoupling will be the same as ours. Each couple needs to find their own way. However, far too many couples do not “uncouple consciously”. Out of social norms that tell us that divorce is wrong, that we have been wronged if a marriage ends, out of anger, loss, fear, hurt, frustration, couples lose sight of the fact that they once loved one another, respected one another,  cared for one another for a period of time. Many still do as they divorce. They lose sight of the fact that their children NEED them to separate as smoothly and painlessly as possible. They lose sight of the fact that they are the role models for their children and how they uncouple will resonate throughout their children’s lives, in their relationships, in their beliefs about commitment.

The dominant cultural narrative has it that divorce means failure, that the marriage was a mistake. We need to change that. Marriages are our commitment to our best selves, the selves we want to share with another. This desire for connection is a basic human drive. For many reasons, this commitment may not last a lifetime, but how we choose to end it, and make no mistake, it is a choice, matters.

Divorce doesn’t make a marriage a mistake!

It was not a mistake to marry my husband. We loved one another dearly. We were wonderful together for a long time. However, we started to grow apart. We started to desire different things. Being together quit nurturing us. To have the lives we wanted and needed to live, to have the lives we desired for one another, we could no longer do it together. It was as right for us to divorce as it was for us to marry in the first place. To divorce consciously was a gift to ourselves and our children. That doesn’t mean that there weren’t disagreements, animosities, frustrations. It means we worked through them with the knowledge that we would be co-parents for our lifetimes, that we had made that commitment to our children.

On Chris and Gwyneth

While tabloids speculate on the sins Chris and Gwyneth’s conscious uncoupling is designed to hide, the point is that it is the right way to separate, the good way to separate, the healthy way to separate. I hope they will be able to maintain this commitment in the face of social pressure that prescribes that divorces be ugly, petty, painful. I hope they refrain from airing any dirty laundry, and none of us is perfect, for the amusement of others. Divorces do not need to be that way. We are better than that. For our children, we NEED to be better than that!

 

Sidelined by broken wrists – Part 2 OR Why I LOVE Frontier Airlines! – October 14, 2012:

For background to this point, please read Sidelined by broken wrists – Part 1 I became aware that my friends were whispering to one another in the van to the airport and wondered vaguely why, but at this point, my pain meds (second dose) were kicking in, and I felt pleasantly fuzzy, so I really didn’t care about anything much. When we got to the airport, Frontier Airlines had a wheel chair waiting for me. They took care of my luggage, gathered my boarding passes, and we headed to security. At security, the TSA agent asked me if I could take my arms out of my slings for pat down. I laughed hysterically. My friend said, “Are you kidding? How could she take them off? Both arms are in slings! Her wrists are broken!”. The TSA agent stepped back abashed and called her supervisor, clueless about how to proceed. Even though it was their wheelchair, I and the entire chair were swabbed for bio-hazardous materials. Then the Frontier agent and my friend wheeled me to my gate. I finally noticed that my graduate students were nowhere in sight.  I asked my friend if she’d seen them. “No, no one has been able to find them or even talk with them since last night. We’ve left about 30 messages with no response. We have no idea where they are.” “Don’t worry”, I said, “They’ll be here”. The Kindness (and weirdness) of Strangers: As time to board the plane approached, it became clear that my students would not make the plane. My friend started to panic. She didn’t want to leave me alone on the plane. I told her not to worry that Frontier would take care of me and that I’d ask for help if I needed it. That wasn’t good enough for her. I had noticed a woman in the boarding gate who kept staring at me. My friend approached her and told her I was flying to Wichita. She was as well and promised to keep an eye on me. Fortunately, as will become clear later, the airline moved me to the first row of the plane just behind the bulkhead, so they could keep an eye on me, and she was seated elsewhere. The flight attendants, and my seatmates, were very attentive from the outset. The flight attendant asked the gentleman in the aisle seat if he would be willing to help me during the flight if I needed it. He agreed and asked from some water for me, holding the glass while I sipped through a straw. I leaned into the plane wall to sleep. As the plane door was about to close, a final passenger entered and claimed the seat in the middle of our row. The gentleman on the aisle quickly explained my condition and asked the newcomer if he was prepared to help me. He said “certainly” and settled in. He looked to me as the plane was taking off and asked if I needed anything. “No”, I said. He looked at me quizzically and said, “You don’t look comfortable”. I then asked if he’d take the hair tie out of my hair. He said he had 3 daughters and would be pleased to help. After the plane lifted off, he helped me put my seat back and I fell asleep. He woke me gently as we landed and asked me if I would like my hair back up. I said yes, and he put it back up. I was the last person off the plane and we weren’t at a gate, so they had to figure out how to get me off the plane. The airline found this cool wheelchair that fit into the guardrail down from the plane. At the bottom of the stairs was the woman my friend had asked to assist me. I didn’t know why, but she made me nervous. The flight attendant rolled me into the terminal and to a spot by a window to await my next flight, placed my carryon luggage around me, asked me if I needed anything, and then left me. The woman from the plane approached me with a cup of coffee. “You don’t like cream, do you”, she asked. “I don’t (drink coffee)”, I started to say, but without waiting for me to finish, she shoved the coffee cup against my mouth and my choice was to drink (it was scalding) or have her dump it all over me. After the first gulp, I coughed and she pushed it on me again. “It’s hot isn’t it”, she asked, pressing her face into mine. “No more, please”, I managed to say. She pushed the coffee into my mouth again. Thankfully, at that point, a Frontier representative walked up and asked me if I knew this woman. I said “No!” and he said “excuse me” while pushing past her, collected my luggage and wheeled me to a Frontier gate counter where a number of Frontier representatives were preparing for flights. “Can you watch her”, he asked. “She can’t do anything and I watched this woman pour coffee down her throat.” One Frontier employee walked up to me and asked how I got my hair up. I shared the story about the gentleman on the plane. She laughed and asked if she could help me. “That bad”, I asked. She raised her eyebrows and nodded, so I invited her to brush my hair and put it back up. She stayed with me until my second flight. On the second plane, the flight attendants again seated me by the window in the bulkhead. They explained the situation to the young woman who was my seatmate and asked if she would be willing to help me. She said yes, but appeared apprehensive. Her parents were with her and she was on a recruitment trip to Wichita State for basketball. Immediately after takeoff, the flight attendant told her it was almost time for me to take my next dose of pain pills, but that I needed to eat first. She paused to let this sink in. “You want me to feed her?”, the young woman asked. “If you’d be willing, if not, I’ll do it”, the flight attendant replied. “No, I can do it”, the young woman replied. The flight attendant brought her hummus, crackers, almonds and olives. She made me tiny crackers topped with hummus and maybe an olive or an almond and fed them slowly to me, offering me water in between bites. I ate a bit as we talked, and then she gave me my pain pill and reclined my seat for me. I fell instantly asleep, but at one point heard the flight attendant ask the young woman how I was doing. “Sleeping peacefully. She ate, drank some water, and took her pill”, she replied. “Thank you for taking care of her” the flight attendant replied. “No problem”, the young woman said. I felt myself smile and slept until they woke me when the plane landed. I was again last off the plane, my friend waiting for me in the terminal.  I sighed with relief, happy to be home.

Sidelined by Broken Wrists – Part 1

Sidelined by broken wrists – Part 1

October 13, 2012:

I was at the annual Organization for the Study of Communication, Language and Gender Conference in Tacoma, WA, October 13, 2012. Earlier that day, I had been awarded the OSCLG Teacher/Mentor Award (to be honest, an award I had coveted my entire professional career). The evening event for our conference was a dance and karaoke party on the University of Puget Sound’s campus. I had purchased and shipped glass for family and friends that day at the glass museum and had dinner with wonderful friends.

At the dance party, I was in line to sing karaoke and dancing to a Madonna song with some friends. A friend came up and decided to spin me. At the height of the spin when I was backwards, she pulled her hand from mine and I went sailing backward, off the small dance floor, went airborne and put my hands behind me to catch myself as I fell. (It seemed like a good idea at the time.)

When I landed, it hurt, a lot, but I wasn’t thinking about my wrists. My first comment to my friend as she apologized and pulled me up by my hands from the floor was “Oh my God! I fell on my ass in front of the Foss sisters!” (top scholars in my discipline). Then I realized that I was really hurt. I turned white and my friend helped me to a chair. I had never felt pain like the pain that was emanating from my hands (that was how I identified it at that point).

I laid my head on the table and asked for ice. My friend got me a large pack of ice and I rested my wrists and hands on it. The pain was getting worse. I asked for more ice to put on top of my hands.  She brought me a smaller bag and I cried as she put it on my hands. It was excruciating. She knelt down next to me and asked, “Do we need to get you to the emergency room?”  I nodded yes and said “But there’s no way I can walk”.

Another friend got a van and 4 friends lifted the chair I was in to carry me to the van. I adopted what was to become a familiar pose over the next several months, my hands pointing upward and across my chest. At the hospital, the nurse who met our van at the emergency room asked, “Was there alcohol involved?” I quipped, “Clearly not enough”. She said, “Good, you have a sense of humor.”

As we sat in the waiting room, my two friends and I, I kept joking about hurting my wrists dancing. That became a pretty popular story that evening in the ER. Through the pain, there was a lot of laughter. When we were finally led back to the examination room, I realized that my fingers were swelling. “Oh my gosh! We have to get my rings off”, I exclaimed. “I’ll cry if they have to cut them off”. All of my rings have stories and are very meaningful to me. My friend took them off and put them in her purse. It was an evening full of waiting, but I was fully present. My friends and I talked and laughed and then one of them would disappear for a while to call and update our friends at the conference about my progress. I don’t know why, but I kept making people laugh. I don’t normally think I’m especially funny, but that night, I guess I was. One of my friends told me the next year at the conference that the nurses told her: “Your mom is a hoot!” She thought I might be offended the nurse thought I was her mom. I’m wasn’t, of course, she’s tall, gorgeous and looks like a model.  I was far from offended. 🙂

We spent from roughly 9:30 p.m. until 3 a.m. in the emergency room. The verdict, a bilateral fracture of my left wrist, a trilateral fracture of my right wrist. After they gave me major pain pills, which they held off on doing until they were sure I didn’t need surgery, they splinted my wrists and put me in slings, my arms across my chest. We went back to the hotel so I could rest a bit before my flight.

My friends tried to get ahold of my graduate students. I was at the conference with 2 of them. We were to leave the next morning for home and had to be at the airport by 6 a.m. for our flight. My friend wanted me to stay with her in Tacoma, but I knew I’d rest better at home, so I declined. After all, I had 2 students with me to assist. What could go wrong?!

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