Less Than A _____ To Live

persistence-of-memory-darker-dali-wallpaperIn the weekly review of our new patients, time contradictions are frequently part of their stories.

A nurse or social worker will include a variation of, “Just before he went to the hospital, his regular physician told him he had months to live.”

I immediately think . . . of course that’s what the doctor said, since Medicare regulations unambiguously state a person appropriate for hospice has six months or less to live.

My thought occurred in split seconds, and before I’m finished thinking it, the same nurse or social worker continues their summary with, “However, while our patient was in the hospital, his surgeon told him he had less than a week to live.”

Months to live . . . one doctor said.

Less than a week to live . . . another doctor said.

Isn’t there a gap in those two “predictions” as long as the season of summer, a time chasm that could be the difference between your best friend (who lives across the country) visiting you again or never again, or it means you might get personal business (credit card debts, letters to loved ones, quarterly taxes, a final trip to the ocean) all in order . . . or left in chaos?

How can that contradiction exist? Why can’t the doctors agree with each other and be on the same page, especially when they are talking about your life, or the life of someone you love?

The answer is found in an irritating, unsatisfying truism: doctors are human, too. One doctor views a fellow human with pancreatic cancer or congestive heart failure and guesses (and it is always a guess) how long he or she might live. The next doctor, reviewing identical information, draws a different conclusion. After all, doctors are influenced by personality traits (optimism vs. pessimism), dread about death (some avoid any end-of-life conversations) and a pass-the-buck mentality (there must be another physician in another office that can deliver the bad news . . . but it won’t be me). The same can be said about patients. Each. Is. Different.

A lot of folks—or at least this is how I would think—assume the doctor providing the information that I want to hear is a more accurate, knowledgeable physician. I’d prefer to live for part of a year rather than a month or less, so the fool who gave me the short straw must be misinformed.

In the span of a week last August, while my mother was dying, various doctors declared Mom had days, weeks and months to live. I can say now that none of them were lying. But back then, consumed with wanting to do everything possible to ensure my family had correct information, and could make the best decisions for Mom’s needs, I staggered between concocting “future” plans for her care and fearing the next seconds would be her last breath. In other words, I was a basket case.

hourglassNow—months removed from that anguish—I reflect back, grateful for one constant when I was so unsettled with contradictory information and ever-changing decisions. Even with pessimism gleefully yanking the rug out from optimism’s next step, I told Mom I loved her every day, every possible moment. I told her when I knew she’d hear me. I told her when I hoped she could hear me.

Listen carefully to the wonderful/awful, faithful/fickle (a.k.a. very human) physicians that are helping your family. They will give too much/too little information. They will linger to explain a concern or try to bolt from the room. Never hesitate to ask the experts their opinions (a.k.a. guesses), but remember some dread delivering the “worst” answer and/or sugarcoat a confusing “safe” answer.

You and I can only be sure of one thing . . . today*.

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

Dali painting image from here; hourglass image from here.

*Without reviewing prior hospice-related essays, this last sentence’s conclusion about “today’s importance” anchors the end of a bunch of ‘em. Am I’m plagiarizing myself? Repeating myself? Do I have nothing new to say? Any of those three are accurate! But here’s reason #4: today is always the only day we truly have. I keep headlining that truth because, like nearly everyone, I need a constant reminder of the preciousness of right here and right now.

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  1. Larry, If you are getting news reports about the 13 year old in Oakland who has been deemed “brain dead” by more than two physicians, yet the family of the girl are praying for a miracle/healing… oh the sadness of the situation.
    Family is not believing the Dr.’s diagnosis. I so wish the family was getting wise chaplaincy care right now. How do you just choose to reject several Drs evidence of no brain activity, nothing that says the child will live again.
    Tough stuff. Thanks for any of your thoughts on this case.

    • Karen…

      Yep, I’ve followed the reports about the teen in Oakland. Sigh.

      When I read about the situation “from afar,” I too wish the family would listen to the counsel of experts. And I would hope those “experts” would include medical and faith-based views.

      But I am guessing that if it was my child, and “experts” told me she was likely brain-dead and at most had a 1% chance or less to live, I’d cling to that 1% . . . at least for awhile. I also wonder how they, as family, would be reacting if it was an 83-year old instead of a 13-year old? Or, how they’d react if her surgery had involved a life-threatening concern rather than “only” tonsils. So many factors come into play.

      One of our best values as God’s creation is the human’s unwillingness to give up, to claim hope in the most hopeless situations. But that value/faith can also cause us to be blind and deaf when others try to help us see and hear and make the “best” (though imperfect) choices.

      Your thoughts?

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