“There are no classes in life for beginners; right away you are always asked to deal with what is most difficult.” Rainer Marie Rilke
There’s an old video game called Prince of Persia. You progress from room to room, and need to choose, hidden among the clutter — shall I take the flashlight or the dagger? or maybe the rope? There is no way of knowing what will come next, what you will need. You just have to do your best, with no time to think, and keep on moving.
Perhaps I am living in a less glamorous version, as I often find myself in cluttered rooms, faced with myriad choices and little time in which to make decisions. And I am forced to move on, not knowing until it’s too late whether I should have taken the scarf instead of the book of matches.
This week, the cat got sick. Lots of scary blood sick. Epic proportions at the emergency vet rip off hospital sick, because it was late at night and there is apparently a tax on emergencies. And, you know, I did pretty well considering. Despite the vet (who was young, and bright, and apparently without empathy) coming on like a proverbial car salesman throwing on options I would never use, literally not taking breaths in the middle of his sales pitches so I had to work at interrupting to ask simple questions, I did not back down. I breathed deeply, persisted despite his intimations that I was heartless and ignorant, choked down my feelings of guilt, and negotiated down the ridiculous list of tests and procedures. Then, I went home to await the inevitable 2 am call that required me to authorize surgery or kiss my beloved kitty goodbye. I’m no fool. It was a quiet night at the hospital, not much business, and I knew before I left that they would find a reason to up their revenues using my pet. I was stuck paying the ransom.
I’m a therapist through and through. That man never once listened, made no attempt to connect with me. He presented no choices, much less their up and down sides. He never brought up the issue of what the animal’s experience might be of the interventions, or whether I may need to pay my rent instead of his inflated fees. That kind of bedside manner just didn’t cut it with me. So, although I authorized what he did, and although my cat is happily home again, I am certain I was taken advantage of and the cat was overtreated and unnecessarily traumatized.
There’s this interesting thing about middle aged brains. They may not be so good at short term fact retrieval, but they are super amazing at connecting the dots. My brain no longer flashes the message, “You are about to die.” when bad things happen. Instead, the message is something like, “I wonder how something good is going to come out of this one” or “Really, do I have to learn a lesson this way??” So, miraculously, even before the 2 am phone call, during which I signed away my next vacation, I realized this would be useful.
It helped that two weeks prior, I had a rather distasteful series of phone calls with my 93-year-old mother-in-law’s cardiologist’s office about some invasive tests they wanted to run on her, during which I explained that she had told me on no uncertain terms that under no circumstances would she consent to any form of surgery for any reason. When I pointed out that visiting their office upset her for days before and after, they responded, “You have to make her come in.” And I said “Nobody makes her do anything she doesn’t want to. She’s 93, and she can do what she wants. That’s why she chose me to have the medical power of attorney for her. (I’m a bitch.)” The parenthetical part was unspoken, but I think they got it anyhow.
Like objects carried around in Prince of Persia, the vet hospital and cardiologist experiences will come in handy–hopefully later rather than sooner. There I will be, on a weekend or in the middle of the night, running on adrenaline because this time, it is a person I have loved for decades. Others will be wailing and flipping out around me, and things may be happening that I have not had the luxury of researching before the event. In short, I will be at my worst, probably confronted by the best our medical system has to offer in times of emergency. Young residents on duty, lots of testing and technology coupled with a dearth of common sense, compassion and wisdom.
Interventions are equated with love—we need to do everything we can, don’t we? Monitors, machines and meds equal expertise. This approach misses a few little bits. In addition to the fact that overtreatment can kill and maim just as well as undertreatment, it is sometimes forgotten that the goal isn’t simply keeping the heart beating. Quality of life matters. Relationship matters. How it ends matters.
It takes experience, courage and wisdom to not throw everything you have at something before you really think it through. Whenever possible, allowing the patient to make her own decisions, maintain her dignity and power over her own life, should be the metric used–not risking days or weeks on life support or in miserable pain, unless that is expressly her desire.
Doing our best requires preparation, and I had a brush up lesson the other night. It will not come as hoped or planned. It will not be convenient. I may be rushed, stressed and emotionally drained, but will still need to make decisions, the results of which I will carry with me for the rest of my journey.
It is important to ask those questions now, be prepared for what we need to know, and defend the wishes of others with conviction. Make sure you know what they would want you to do. Ask them. If you think it’s tough now, imagine how it will be if they can’t answer for themselves and you have to guess, while being pressured by strangers and emotional family members.
No matter what is going on, and no matter how harried or guilt-inspiring the professionals we are dealing with, we have a right to expect an explanation of the risks and benefits of any procedure and any potential effects on quality of life. They should be put clearly, in terms we understand—as technical or simplified as we wish. We have a right to facts, not scare tactics, not the bum’s rush.
So, thanks rip off vet. Maybe that wasn’t such a high price tag after all, and I hope you win the sales contest.