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End of Life or Beginning of Death?

Yesterday I watched a woman scoop up her dead cat from the side of the road.  The look on her face was Munch-worthy anguish, and the image is forever burned into my brain.  Her shoulders shook with grief as she shuffled back toward her house, carrying the limp cat on outstretched hands.  I thought about her all day long.

I wondered if she took some comfort in the fact that the cat probably didn’t suffer, that it most likely died on impact from a speeding car and never felt a thing.  I guess you could say the cat was spared the demise that many humans with Alzheimer’s disease have to endure- the long, slow road to death via “natural causes”.  I know many of them who would prefer a sudden roadside burial.

I don’t know the answer to the moral dilemma of self-determination vs. the right to die vs. the exact moment that we stop prolonging the life of someone who is no longer “useful” or even self-aware.  The revolving hospital-door at the end of life care can spin in a dizzying cycle for years on end, leaving the faces of caregivers molded into a perpetual “scream” of despair and longing.

I hope that today the lady with the dead cat can move on to the next phase of healing.  For my bedridden patient with Alzheimer’s disease, who was discharged from hospice care back to the mainstream healthcare system after two years because he didn’t die within a reasonable period of time, whose limbs are contracted at the hips, knees, and elbows so that his body is hooked into a human question mark, whose hollowed eyes and sunken cheeks are frozen into yet another “Scream Face”, who is so rigid and bony that his next infection is likely to come from a bed sore- if pneumonia doesn’t get him first-, whose only interaction with the world is a soft moan when a well-meaning caregiver tries to reposition him or change a soiled diaper…  Today I will try to bring him comfort, and probably extend his life.

He is able to swallow and breathe and excrete, so therefore he lives for yet another intervention, another well-intended therapist who wants to lessen his pain and make his caregivers’ jobs easier.  We will continue our approaches until he is again appropriate for hospice (worthy of dying), or an acute illness (speeding car) ends his misery for him.

A cat in his condition would have crawled off into the woods by now… but humans are trickier. We fight nature.  We delay the inevitable because it feels like control.  I don’t think we can mandate, regulate, or protocol this moral challenge, but we’ve got to do something.


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