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[personal profile] dichro
Six years ago, on the cusp of my moving to the US, my grandmother suffered four heart attacks in rapid succession. Despite the emergency dash back to Perth from Sydney to see her, the emotional trauma, work stress, my telling her I loved her for possibly the first time in decades and so on, I can't find anything that I wrote on the subject. Livejournal is bare. I'm more than a little perplexed; how many things have fallen away because I didn't write about them?

I'm now on my way back from Perth again, to an even further home, in much the same circumstance: she had a stroke a week and a half ago, and has been more or less comatose in hospital ever since. I remember it seemed dire then as well, knowing that the next one could kill her, but it's worse now, since it seems that she's already gone.

We cling to the notion that on those rare occasions that she opens her eyes - usually in response to cleaning, turning, bathing or other insult by the nurses - she can see us, recognize us, and that it means something. We imagine a smile on her lips, a weak signal overlaid on the regular curve of her breathing. One of her own daughters had a stroke in her 70s, lay unconscious for three weeks, and recovered. But my grandmother is 102, and the medical verdict is for palliative care only.

There's a lot of decisions that are made away from the family and the patient, but it seems that they largely stem from a single, important difference: whether to treat or not. Rationally, statistically, I imagine that it must seem an open and shut case: patient, elderly, really elderly, major cerebral infarct, unresponsive, not improving for several days. Initially withhold IV nutrition, later remove oxygen and IV hydration as well. Let nature take its course.

I do wonder if there's some shadow of the public-vs-private healthcare debate here; if a private hospital would be content to keep a body in bed as long as somebody was willing to keep paying the bills. But in a public hospital, where beds are always in short supply, one triages even in the geriatric ward.

The medical specialists didn't always seem to be in agreement. RPH is a teaching hospital; perhaps it was one of the younger students who reacted with such shock a few days earlier when we first suggested taking her home, stating emphatically that while she might not get better in hospital, she definitely wouldn't at home. But the palliative care specialist, despite some epic circumlocutions, did eventually confirm that the IV hydration had been withdrawn to avoid prolonging life unnecessarily.

After I spoke to her privately, using the phrase "terminal congestion" in a leading question to establish my faux fides, she confided that a patient who reaches such an age in otherwise reasonable health can be assumed to have some biology working for her, and it's conceivable that with minimal maintenance she could linger for weeks, perhaps months; clearly unthinkable.

The family have decided to take her home. It'll be happening today, perhaps tomorrow. Palliative care are familiar with the scenario and can assist with all the necessary people, equipment and procedures. I won't be there; I'm taking my persistent wracking cough back home to meet other obligations. I tried to say goodbye; we're all hoping or pretending that it had some meaning, that there was enough of her there, locked away behind her untracking eyes to understand it. I do think she smiled.
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dichro: (Default)
Miki Habryn

April 2017


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