The Bittersweet End

Birth and death are two sides to the same coin. I remember when my son, Dylan, was born. It was one of the most frantic episodes of my life. It started with the routine GYN appointment for my wife. She was post date, so it was standard protocol to have a visit with the GYN every week. On this particular visit, they discovered that she had low amniotic fluid during the ultrasound, so her doctor recommended that we induce. In that second, my life changed.

We picked up some things from home and headed over to the hospital. After we were admitted, they started a Pitocin drip. After several hours of walking and bouncing on a ball, the contractions started. At first, mild, but as the day went on, they intensified. By nightfall, my wife was in so much pain, that she could barely move. We initially had planned for a natural birth, but when the going got rough, the tough got an epidural. The epidural eventually took effect and my wife was able to function again.

During my residency, I delivered babies before, but when you’re on the other side of the drape, you forget about everything, which is why it’s best that the professionals handle it. The one thing I remember after my wife was prepped for the delivery was how violent it was. From the pain, to the blood, to the screams of agony and joy, labor is downright barbaric. In the end, Dylan was born, and my life hasn’t been the same since then.

At the end of life, it’s like a mirror image of the beginning. There is a struggle, where there is perhaps, blood, pain and tears, that eventually lead to the final stage of the death crawl, where a person takes their final breath to the sweet release of an end. I’ve witnessed this, too. More than I would like to admit. The difference, however, between birth and death, is the sentiment behind the two; the joy at the beginning and the sadness at the end. It’s that sadness, I believe, that results in the reluctance to get the proper care a loved one needs in the end. It’s a silent denial that the end isn’t the end.

I have a patient named Roberto, who is ninety-three years old. He cannot walk any longer due to a stroke he had several years back and is wheelchair bound. He is blind in one eye, is no longer continent, and is demented but still able to carry a conversation. He comes in with his son, who is his primary caregiver. When I look at his son, he always looks exhausted. Taking care of his father is a 24 hour job. “I have no time at all for myself,” he says. “I can’t run any errands and I can’t afford any more help. The home nurse is only at the house a few hours a day, but it isn’t enough.”

The home health service recommends a hospital bed along with other things, like a hoyer lift, extended health services and a home MD for evaluation of the patient. All of these things are appropriate for Roberto, but they come with a cost and unfortunately, Medicare isn’t going to foot the bill, which leads us back to the son. I tell him that his father is a good candidate for hospice. “But my father isn’t dying,” he says.

Most people view hospice as an end of life service for only terminally ill patients. The truth is that hospice is a service that incorporates much more. Hospice, or palliative care, which is a better term for it, is a service that is intended to make a person’s end years comfortable; this does not mean through pain medications only, but also to provide support to the family, provide nursing care for basic life needs like toileting, feeding, and dressing. Its mission is to provide the patient with some sense of dignity at the end of life. I have actually had patients admitted to hospice only to be discharged six months later due to the fact that they had improved. This is because of the comprehensive care you receive while under their care. In addition to this, Medicare will pay for hospice. if you have questions about hospice, ask your doctor if it makes sense for you. You may be surprised.

I tell Roberto’s son about hospice and place the referral. He still isn’t grasping the reason he needs it, but hopefully, they will be able to convince him. Honestly, there is no dignity in death, just like there is no dignity in birth. It’s all just a big, violent mess. Even with the right plans in place, any transition in life is hard. Saying goodbye is never easy, but with hospice, it hopefully won’t be as difficult.

By: Dr. Juan Borja
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