Monday, July 09, 2007

The long goodbye

My mother-in-law is slipping away from us. We spent time visiting with her in a nursing home this weekend; she was discharged from the hospital the weekend before last but could not go home because her needs for care exceeded anything my father-in-law could provide.

It's a Parkinson's-like condition with continuing deterioration, although the rate of decline exceeds what might be expected in most Parkinson's patients. In the course of a year she has gone from being able to provide most of her own care to being immobile from time to time, from speaking small sentences to virtually not at all, from recognizing everyone and being able to participate in small ways in conversations to being withdrawn, disinterested and unable to recognize even her own children.

It's very hard to watch, and it's caused a few heated discussions between my spouse and me. And between my parents, too; having shared some of the details with them, they've discussed the situation and found themselves arguing over how life should end, just as my spouse has been arguing with me.

We've been saying goodbye for at least five years, slowly escalating the departure, and yet we still cannot do so without argument.

My parents are adamantly against intubation of any kind; if they cannot be assured of return to a condition they possessed before they needed the tube, they don't want it. This is what their Do Not Resuscitate orders reflect. But my in-laws are already over that line, with my mother-in-law now on oxygen and quite possibly on a feeding tube very soon. My folks would rather have none of it, would rather be doped up on pain meds and allowed to slip away altogether.

My father thinks I'm misunderstanding what DNR means; my mom doesn't think so, and they butt heads over this. But it's not about me, nor about my parents. It's between my spouse and his parents, and this is what they've chosen, a very long goodbye. All I can do is try to ask questions if I think it sheds more light on decision-making, and prepare my kids for the departure ahead.

The most difficult part of this situation is that from time to time, my mother-in-law seems better. My sister-in-law caught her at one of those points yesterday, and doesn't believe what I saw the day before. My mother-in-law couldn't sit up, couldn't lift her arms up, couldn't adjust her oxygen tube, could only lay in bed. She couldn't say any of our names. She slipped in and out of sleep even though late in the morning. But she could recite names to my sistern-in-law, even told her she wanted to go home during a visit later in the day.

I wish I could believe this; I don't think at all that my sister-in-law saw something other than what she reported, but I don't believe she saw something that is long-lasting.

It might only have been a short respite to allow her to say goodbye.

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