|
End-of Life care: a true story -
© 2001 Jeffrey P. Buhrman
I first met “Maria” at church. She was a bright 82 year-old lady,
unmarried and without children. Her closest relatives were a very ill
older brother, his devoted wife, who herself was battling cancer, and a
nephew who lived away and had an active career. A back injury made it
hard for Maria to walk or sit comfortably, but otherwise she was healthy
and alert. She took time to put her legal affairs in order. She wrote a
last will, signed powers of attorney, and planned her funeral. Although
Maria had many friends, she asked me to help her in the event she was
unable to help herself.
Ten months after I met Maria, she had a medium level stroke which sent
her to a medical hospital and then to rehabilitation. After her stroke,
Maria was mentally confused. She recognized me and her friends, but she
was unable to read or write. She told me stories, some odd, some
troubling, which I listened to and “processed” as best I could.
Although Maria was very anxious to leave the rehabilitation hospital, it
was not possible to send her back to her apartment. Maria needed
physical therapy and constant supervision. To alleviate her distress, I
placed her in another skilled-care facility.
After a short while, however, Maria stopped working with her physical
therapists, and another change of residence was needed. Maria‘s friends
and clergy convinced me that too much personal care assistance could
hinder her chance for improvement. It seemed best to place Maria in an
assisted living facility, where she herself would have to attend to her
basic needs, but help would be close by. After considerable searching, I
found a pleasant, home-like facility, where Maria could have 24 hour
supervision, housekeeping service, meals and access to a variety of
daily activities. Once the decision was made, I called Maria’s friends
to pass on the new information, so they could stay in contact. Several
were instrumental in helping Maria resettle and adjust to her new
surroundings. Still there were plenty of things for me to move:
bookcases, chairs, lamps and other personal belongings. Plus each change
brought a mountain of paperwork to review and sign.
Once Maria was safely housed in her new quarters, I studied her
financial situation. Her stroke made it necessary for me take over her
financial affairs. There was much to learn about Maria‘s income,
expenses. assets and liabilities. I prepared a cash-flow projection and
an estimate of how long Maria’s assets might last at her new level of
spending. I inventoried her assets and started an accounting to show all
financial activities.
Maria owned a condominium which she leased to a tenant, I reviewed the
insurance coverage and rental agreement and introduced myself to the
management company. The tenant wanted a few repairs and I looked into
her requests and arranged for the work to be done. Maria had several
bank accounts and stock certificates, so I gathered most of them into a
single, new cash management account. One bank account I left open to
collect her automatic deposits. I closed Maria‘s safe deposit box. Maria
owned a car, which I kept insured and off the street until it could be
sold. Fortunately, a friend allowed me to winter the car in her
driveway.
Maria’s apartment was no longer needed, so her sister-in-law and I
arranged for her excess furniture to be moved and stored. Maria‘s
friends were a great help in boxing up her belongings. A few minor items
were discarded, others given to charity. Utilities were shut off,
accounts cancelled, and mail forwarded. Some personal effects I gave to
Maria’s friends, as her Last Will intended. There were credit cards and
subscriptions to cancel, invoices to question, and so forth. I prepared
and filed Maria‘s income tax return and continued her pledge to her
church; as she would have done herself.
While all of this financial business was occurring, I continued to visit
Maria and pay attention to her condition. She seemed exhausted too much
of the time. I ordered a review of her medications. One of her friends
found Maria soiled when she visited her. I asked her attendants to check
on Maria more frequently. She also battled depression and I talked to
Maria’s clergy and encouraged their visits. I also encouraged her
friends to read to Maria - something she loved but could no longer do
for herself.
On a few occasions, I and others took Maria on outings, even though
these trips were arduous for her. We made a major trip upcountry for a
memorial service for Maria‘s brother and sister-in-law. During the car
trip to the chapel, a place Maria had visited often, she was very
disoriented. Yet when we arrived and she saw where she was, Maria
transformed into her former, alert self. The chapel had many steps up
and down and Maria was wheelchair bound, so we carried her up to the
service and then down into the basement for the reception, and then back
up to ground level when it was time to leave. At the reception, Maria
carried on gracious conversation with her friends and her brother’s
friends and family. It was wonderfully mysterious to see her gather her
energy for a last public appearance.
Weeks later, Maria contracted a respiratory infection. Late one night
her infection became serious and Maria was rushed to the emergency room
before I was contacted. I visited her there. Maria‘s condition was poor
but her care providers acted quickly to stabilize her. I admitted Maria
to the hospital. A few days later she was discharged and sent on the
rounds to skilled-care nursing, physical therapy, and back to assisted
living. This course of action might have been all well and good had
Maria been stronger, but each transition weakened her and compounded her
distress. Her quality of life was deeply impaired. From my conversations
with Maria prior to her stroke, I knew she did not want to live out her
life in this way. I had several discussions with staff where Maria
resided to ensure the cycle would not be repeated. Maria’s clergy guided
me in this difficult decision, and her doctor agreed to write the
necessary order to withhold further antibiotic treatment. A month or so
later, Maria contracted another respiratory infection and died of
pneumonia.
My work did not end with Maria‘s death. I acted as her executor and
probated her Will. Her financial affairs were in good order, so that
task was comparatively simple. Of more concern was her cremation,
funeral and burial. I wrote her obituary. As for her funeral, Maria had
planned most of it in advance and her clergy helped me fill in the
details. They also directed me to an outstanding funeral director who
helped me choose an appropriate casket and urn. Since Maria died during
winter, her ashes were interred the next spring at a graveside ceremony
in the small rural community that had meant so much to her.
DISCLAIMER: This web site is provided for general
information only. It is based on Maine law. The law may apply
differently to your specific situation. Readers should seek competent
legal counsel for solutions to their individual problems and advice
about their individual situation. This web site by itself does not
establish an attorney-client relationship, nor should anything in this
web site be considered legal advice.
|
|
