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"What if it was YOUR mother?"

Posted by Dr. Lachlan Forrow  August 12, 2013 09:19 AM

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End of life decision-making can be agonizingly hard, especially when we haven't had "The Conversation" with our loved one.  

But sometimes it is remarkably easy to figure out what Mom would (and wouldn't) want, even if it's now too late to ask Mom herself.  And often the answer emerges most clearly when we stop thinking in terms of the specific medical "questions" we seem to be facing -- "If Mom's heart stops, would she want CPR?"  or "Would Mom want to be kept on the respirator?"  The crucial issues aren't, in fact, usually "medical" -- the crucial issues are usually about Mom herself, Mom as a person.

One of our medical residents at Beth Israel Deaconess Medical Center (BIDMC), Dr. Haider Javed Warraich, recently conveyed this beautifully in an essay for the NY Times titled "If This Were Your Mother, Doctor...".  He describes a recent "family meeting" he participated in, in one of the medical intensive care units.  The patient was an elderly woman, admitted to the MICU just a few hours earlier, after requiring "intubation" (ie, being placed on a mechanical ventilator), which was now keeping her alive.  After an initial discussion about the complex medical issues with the patient's two daughters and her son, Dr. Warraich writes that:

The son, quiet for most of the meeting, broke the silence and, with a hint of anger and a big dollop of frustration, asked the one question I had dreaded being asked the most: “Doc, give it to me straight. If this were your mother, what would you do?” 

Fortunately, Dr. Warraich understood that the issue he was trying to help this family with was not about his own mother, but was about their mother.  So instead of talking about his own mother, he paused and then simply responded, "Tell me more about your mother.”

And then, slowly, the family started sharing stories of the woman we had met only a few hours before, unconscious and intubated. She loved being independent, would hate for people to open doors for her or hold her hand as she tried to get up, they told us. She loved the sun, the beach. She loved walking, loved being out and about. She would never, ever want to go to a nursing home. Never ever. They pulled out a picture of her lounging on a chair, sipping lemonade.

We then told them that based on a combination of her vital signs and lab values, as well as our clinical judgment, that while we could hope for some progress, it would likely not be enough to allow her any real shot at experiencing life outside a nursing facility again.

The daughters shared another glance with their brother. Their shoulders were now less tense, their eyes less teary. The room seemed to be filled with memories of a woman who had lived life well. They turned to us and asked us to make her comfortable, and to turn off the breathing machine. 

I hope that Dr. Warraich's wisdom is read widely by doctors and nurses, who are so often asked "What if it was YOUR mother?".  But his reflections about how to respond to this question are just as relevant to anyone who is asked a similar question by a friend or neighbor, which sooner or later may be most of us. 
This blog is not written or edited by or the Boston Globe.
The author is solely responsible for the content.

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About the author

Lachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »

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