The complexities of life

Sometimes the issues attendant upon possessing and living with an elderly relative are, or gradually become, complex, disarming, enlightening and occasionally bizarre. Perhaps, simply because human society is such a contrary and wonderful thing, nobody should be surprised about this.

In addition, no doubt, a degree of the confusion and awkwardness I’m obliquely referring to here stems from the fact that so often we regard matters pertaining to decline and demise as taboo, preferably to be ignored and avoided unless absolutely necessary, which is puzzling in itself because, of course, they happen to us all, and to every family, from time to time.

And when they do, presumably, the vast majority of us just get on with it because that is what human beings do. I’ve made mention previously of the truisms that making a will, or addressing the topic of making a DNR (‘do not resuscitate’) declaration – or indeed not making one – and/or of how dealing with serious illness or even a death in the family can simultaneously be one of the simplest and yet weirdest things one ever does in this life.

Weird in the sense that, as often as not, a family coping with serious illness or even a prospective bereavement has two key tasks.

The first  – fundamental and relatively straightforward – is to find a way to ‘get through’ their situation that works for them.

And the second – rather more complex and demanding – is that of accommodating and dealing with all the many and varied ways in which other people (friends, extended family, acquaintances, work colleagues, local busybodies, medical or religious professionals, and just general third parties) can and/or do react to it.

In the past few weeks my own family has been gradually edging towards dealing with some medical profession issues relevant to my elderly father, not least the DNR one I mentioned above and that arranging for a cognitive test to be carried out in order to establish where, on a recognised spectrum of mental frailty, the subject currently stands simply so that over time one can monitor his or her progress down the inevitable slope.

As I understand it, advised by my father’s carers, it is important to address the DNR subject with every elderly person. In other words, to give them the opportunity to express or declare a view on it, if they have one.

This is against the background, of course, that – if they don’t have a view, or don’t wish to express one, or even haven’t ever addressed the subject of DNR – then they have effectively already ‘made a decision’ upon it anyway, i.e. by default.

Here’s the scenario, as I understand it.

Elderly person at home, possibly attended by carer, or friend, or member of the family.

Elsewhere, the medical professionals – e.g. the doctor, paramedic, carer, ambulance driver and/or nurse – all of whom are under a legal and moral obligation/duty (let’s leave the Hippocratic Oath out of this for present purposes) to do everything in their power to preserve and/or save human life if they possibly can.

One day, said elderly person collapses to the floor, having suffered a cardiac arrest. The friend, carer or family relative calls the emergency services and an ambulance duly speeds to the scene.

Practically the first thing that happens upon arrival is that the head medical professional on hand asks if a DNR declaration exists (by which I mean specifically a doctor-certified one).

Unless one exists – and it contains a statement to the effect the elderly person concerned has specified DNR – then the scene and what happens next proceeds on the basis that the medical professionals on hand are going to do everything they can to revive and/or ‘bring the stricken person back to life’, end of message. Because that is their honour-bound duty.

This could be distressing for the medical professionals present, never mind any non-professionals onlookers because sometimes doing all you can in the cause of ‘saving somebody’s life’ can result in some drastic and/or unpleasant measures being taken.

Let me refer back to my comment earlier about ‘not making a decision’ on DNR effectively being a decision in itself by default. Because if no DNR declaration exists, to all intents and purposes, in a life and death situation such as this, this amounts to a declaration that the individual wants everything medically possible done to ‘bring him (or her) back’.

However, suppose the elderly person has made a doctor-certified DNR. That means that the medical professionals who ever attend him/her in a ‘life or death’ situation can do nothing more than make the elderly person as comfortable as possible.

It is not just that they are free not to try and revive the elderly person, they are actually under an obligation (via the DNR) not to do so. Which, in an emergency life or death situation, can be quite as distressing for everyone present – medical professional or not – as the process of trying to revive them.

Separately, on the subject of my father taking a cognitive test.

A fortnight ago, by arrangement behind his back, my brother and I deliberately went to see his GP to discuss the prospect of subjecting him to a cognitive test. This was agreed and a date set.

Yesterday morning – on the back of discussing things in general and raising the possibility that he should consider making a DNR declaration – my father was taken to said appointment.

The family had blithely assumed that, using his best bedside manner and experience in dealing with such subjects, the GP would subtly and gently (without revealing our involvement in ‘setting it up’) raise the subject of taking a cognitive test, almost without my father noticing.

When the appointment party returned, I was somewhat dismayed to learn that none of this had happened as planned.

Instead, when the GP suggested out of the blue that he take a cognitive test, not unnaturally my father asked “Why?”

The GP replied bluntly “Because your sons have asked me to get you to take one”.

Thanks, pal!

[One aspect, as reported, that did subsequently make me smile was the beginning of the test. The GP’s first question was “Do you know what year it is?”, to which my father answered “Yes”, which in one way – if you think about – was a perfectly straight answer (possibly) to a straight question …]