By Darcy Thiel
After losing Mom and my husband, writing books about it, and becoming credentialed as an aging life care manager, I assumed approaching Dad’s death was going to be the best death I had the privilege to be part of. I know that sounds strange, but I had become educated and knew when Dad switched to palliative care, when his time came, he would not suffer. I promised him that.
I had absolutely no idea what I was talking about.
Over the last decade, I became increasingly involved in his care. He had Parkinson’s disease and we began the journey of educating ourselves the hard way. After treating swallowing issues and bladder disorders for years, we were finally informed they were symptoms of Parkinson’s. Itchy skin. Blood pressure. Is there anything this thing doesn’t touch? It’s a slow progressing disease that makes life miserable but doesn’t have the courtesy of actually killing you. At least not for years and years.
My family and I helped him “get his affairs in order” over time. He slowly made changes financially and legally to put him in a good position. He sold his house and eventually landed in assisted living, just down the street. While it seemed crazy expensive, finding out about a VA benefit made it almost affordable. He would have three meals a day, have his apartment cleaned and his laundry washed.
We made sure his medical papers were ready. We had lots of discussions about his wishes so I could be a good health care proxy if need be. By the time he turned 85, he had lived a good life and was ready for the next and a reunion with his wife.
In July, Dad starting experiencing pain. Spoiler alert: Two of the last three weeks of his life he lived with increasing pain. I knew our medical system was broken – I just didn’t realize how badly. Medicine has become a for-profit business, which usually means money is more important than patient care. No matter how much I advocated, I couldn’t beat the facility or the medical persons they contracted with. It became crystal clear they didn’t understand palliative care or that palliative and hospice were no longer interchangeable. More importantly, they didn’t want to. Professionals should inform patients of treatment options and expected outcomes. The decision to treat (or not) should be the patient’s, not the doctor’s.
I could not get the administrators to see what was happening. The staff would often shudder at what they witnessed, but were powerless. His primary would not prescribe enough pain medication and refused to order a catheter in spite of his fall risks. There was blatant refusal to accept his MOLST (Medical Orders for Life-Sustaining Treatment). It finally culminated in them blocking hospice from treating him. Yes, you read that right. Eventually, they were cited by the Department of Health for failure to comply or I can’t imagine how bad Dad’s suffering would have gotten.
I later discovered that about four years ago, regulations were drastically changed. Dying is not enough to gain hospice care. You have to have a terminal illness to qualify. How do I keep heralding the advantages of palliative care if there is no one to help folks when they get to that point? Hospice can’t be happy about this either.
I will never, ever forget the look in Dad’s eyes when he was hurting and I could do nothing for him. The several individuals who refused to do proper research and care for him appropriately should not be practicing. You only get to die once. Why should a decorated Korean War veteran, after working his entire life in an American factory, and as a volunteer firefighter for 60 years, have to suffer at the end of his life? If you can answer that, please tell me. I would do anything to make sense of it.
Darcy Thiel, of West Seneca, is an aging life care manager.