How Do You Choose For Him To Die

I’m going to share a story with you.  It is based in truth but I’ve changed facts so that you get the idea only of how this stuff works without telling you about the real person.

This is how things work, or don’t work.  And the resulting torment.  For anyone who cares.

I investigate allegations of abuse, neglect and exploitation of the elderly.  And people, let me tell you, there is a hell of a lot of that going on.

Imagine a 99 year old man.  Living in his house.  Alone.  That he has lived in for over fifty years.   Fifty years of it alone because his wife died young.

To this point in time he has never moved.  Choosing to stay where he is for whatever reason.  Even though the house that is his armor and shield is wearing thin and doing little to keep him protected.   It has piled up with the things he can no longer bare to do away with.  The dirt is increasing because he can no longer keep up with it.  Or, he has always lived with it because it didn’t ever matter to him.

Anyone he knows has either died.  Or they are as elderly as he is and can’t get to him any more than he can get to them.

His home is where he wants to be.  And it’s all he wants.

He walks.

He eats.  When he feels like it.  Which doesn’t appear to be often enough.

He is dressed.  But in the same clothes he has been wearing for possibly a year.

His hair is matted.   And you can see “stuff” in his hair, on his scalp.

He doesn’t smell very good.

He doesn’t go to a doctor.  He knows a doctor will make him change.

When people talk to him he can “hold his own” and refuse their offers of help.

Help is offered.  Because this world is full of kind and decent people.  People are willing to help, if only they knew how, and if only he agreed with them that he needed help.

He wants nothing from you.  Nothing but to be where he is.

He is 99.

What do we do?

We do nothing.   And he stays there.  Dirty.   Alone.  And he will die.   He will die where he wants to die.  He will exist and die in the one place that he found safety and comfort in this world.  Dirty.  Unkempt.  Alone.   For whatever reason.  He stayed when he was able to make other choices and act on them.  He stayed as he aged but was still able to make changes.    He stayed there alone,  by choice, for what he believes to be forever.

We do something.   Steps are taken to make him do something he doesn’t want to do.  He will be cleaned to make others feel better.  He will be spoken to kindly.  He will have something fresh to eat every day.   He will die.   Removed from the one place he could never make himself leave.  He will die, surrounded by strangers, in a place he never wanted to be.

How do you value a person’s wishes when those wishes leave him alone, unkempt, dirty and uncared for.

Is my value of wanting him clean, safe, well fed, ministered to by caring (even if paid) hands who will make sure he is how we want him to be, more important than the value he places on where he is.

Is my value of how I think he should live, more important or dare I say-right-than his value of staying where he is.

His value:  independence/home/his choices/his way/however he can manage alone.

The other value:  dependence/institution/not his choices/not his way/clean-fed-medicines-socialization.

Either way, he will die soon, it is the way for us all.  No one can stop that.

But in what manner.

If you must decide:  do nothing or do something.

How do you choose for him to die?

 

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60 thoughts on “How Do You Choose For Him To Die

  1. Tough one. I’d try to leave him home and see if I could find a volunteer to come bring him meals on wheels and help clean him, to keep him comfortable, etc. As long as he’s lucid and can understand then perhaps present him with the dilemma of leaving him alone uncared for and unclear can be a health hazard and intervention may be necessary so please help us help you with some home health or volunteer help. Really tough one though. My heart’s with him. And, all trying to minister to him.

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  2. bikebrown says:

    As long as someone is mentally competent and not breaking any laws they have the right to live in a manner which suits them. Why should they lose this right just because they get old? If this person was 49 would we treat them differently? Sorry but I don’t have any easy answers.

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  3. Oh, what a painful story, Colleen. I have no answers. It makes my heart ache, however. Are these the only two options? Surely there is a way somewhere between these two extremes. Bless you and your work, my friend.
    Hugs,
    Kathy

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    • I’m only giving the skeleton of the story of course. But truly it is pretty much do nothing or force the issue. He has been offered many services, refused them all. Kind people have offered, he has refused. It’s so hard to sometimes know what to do. Either way, it seems wrong. Thanks Kathy. Hugs are kind of needed.

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  4. Robin says:

    Very tough decision, but based on my own experiences, leave him be. If he’s mentally capable of making his own decisions, then it doesn’t seem right to interfere, no matter how much we may want to step in to try to make life cleaner for him. Perhaps this is his way of working something out, squaring things up in the end.

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    • That’s what I wonder. Why, over all these years when he could have made things “easier” or “better” for himself….did he choose to remain where he is and how he is. There are reasons, and things, we just don’t know. Thanks Robin. I lean towards your answer. But then I ponder some more….and…..wonder.

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  5. I will tell you a little story about an elderly blind man. The same thing happened to him… he knew every inch in his house that was dirty.

    People came to see him, and they cared so much… that they had him taken out of the only home he knew. They took him to a nursing home who took his little can of snuff from him… his Vicks Vapor Rub he used to help him breathe. Every little comfort he ever had… was now, gone.

    He was always promised by his family that he’d never be taken to a nursing home. But… like in your story… people wanted to take him out of the dirty house… instead of taking turns to simply go in…. use a little elbow grease to make it as clean as they wanted to see. He couldn’t see it… so, he didn’t pay it any mind. Every person that complained… was strong enough to go there, do something to make life better for him. They didn’t….

    I went to see him in the nursing home. He was crying… he had a habit of using snuff which was gone. Now… is that right to take the only thing he had to make him happy… away? I talked to the nurse… she was so hateful on top of saying there was no way he could possibly have his snuff in that nursing home. She used that tone with him… he couldn’t see how hateful, mean …her face was. I wanted to slap her down… I didn’t.

    He told me that he wasn’t staying in that nursing home. I worked at the hospital across from the nursing home. He was brought to the hospital, admitted that night. I went up to see him that night… what I saw on his face as he lay sleeping… told me that he was going to die. He had that ‘soft, gray, velvety look’ to his face. I told my cousin to come look… she never saw it. I told her that he was going to die; I ‘knew’.

    He was brought down the next day to have an x-ray… I’ll never forget it. I was called back to the x-ray department… my step-grandfather, the only one I ever knew… had just died.

    I walked back there, stood in front of the stretcher. I pulled the pure white sheet back… there his face was. He looked as if he just exhaled his life completely out… until peace came onto his face. I’ll never forget crying as I looked at him… I ‘knew’ he meant… to die. He meant he wasn’t going to live at a nursing home… he told me so.

    I didn’t mean to write such a long comment, Colleen. George, my step-grandfather was just like this man… living in his very own home. No matter it was dirty… he was comfortable, knew where everything was, made his own choices…

    I answer this… let the man alone. Go, use a little elbow grease, clean a little at a time until it makes whoever is complaining… happy. I’m sure they have some time to spare… the only problem is… just knuckling down to do it.

    GG/G :)))

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    • Thanks GG/G. 🙂 Your answer was not too long at all. I appreciate the story. It is so very hard.

      I will say, that here, there are a LOT of kind hearted people AND agencies. Many who would put in the elbow grease if he would allow it. He is NOT allowing it. I think if he just allowed SOMETHING it would make it more bearable to let him be where he is. That’s the hard part for so many. Knowing things could be nicer for him. Grant it, it is nicer by OUR standards, not his.

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  6. tric says:

    I wrote about a different but similar character once. As part of my community nursing our job was to call to an elderly reclusive ladies flat. She never answered the door, but we knocked until she roared out “f**k off” and then we knew she was alive. I used to think it was not right but maybe in hindsight it was the right thing to do for her, especially after reading this post.

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    • I did read that. 🙂 This fella isn’t quite as vocal. 🙂 But he pretty much says the same thing. Thanks, but no thanks. I liked that story. And the ‘f**k of” was at least a way to say “IM OKAY!”

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  7. Anonymous says:

    Leave him be… But always ask / knock and when he says f*ck off, then their is your answer.

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  8. Mustang.Koji says:

    Man, Chatter Master, you really know how to bring a point or dilemma home… and that’s said in a totally positive light. I don’t think you’re asking but if it were me, I’d let him be and let him peacefully pass away in his home that he and his long-departed wife started… Giving him a measure of dignity now is not important to him…

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    • You’re right Koji. It’s not what he wants or needs. ANd I am asking. It’s not an easy thing to see. It’s hard for others to understand “why” someone would “want” to live like that. His dignity is found in his independence, regardless of what his independence looks like.

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      • I suspect I am with Koji on this one. I remember when the doctor told me he felt it was time to put my dad in a care home. My dad walked to the grocery store everyday, cooked his own food, and basically took care of himself. He had yellow sticky notes up around the house to remind him of everything. He did not want to go to a care home. I agreed with him. Five years later he died in his home at the age of 88… doing what he wanted to do.

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        • Thank you Curt. I love the homes with the sticky notes. It shows they know what they need to do. I’m glad your father remained home. So many don’t get that opportunity. We have talked with many doctors who struggle with this as much as we do.

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          • You are right about the tough call. But a person’s independence is a precious thing… and the alternatives, nursing homes, care centers, etc, are frequently less than desirable, even the more expensive. –Curt

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            • Too often too true. I have to admit when I started this job so many years ago I didn’t fully understand or appreciate the independence factor. I thought…neglected? Get them help and care and everything “I” think they need.

              It’s been a lot of years of education. And meeting wonderful and experienced people who say “leave me alone” in hundreds of different ways to see what independence means to us all.

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  9. Mustang.Koji says:

    Reblogged this on Masako and Spam Musubi and commented:
    This dilemma strikes me solidly… What would YOU do?

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  10. russtowne says:

    I would let the man live and die the way he wants, checking in on him occasionally to make sure he has food (and medicine if he is on any).

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  11. I agree. Leave him be. If he is lucid and it sounds like he is, don’t take away his freedom of choice, his independence, be it as it may.

    This is an impossible situation.

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    • Thank you Tess, it is impossible. I very purposefully did not include all details. And I’m glad you made this point….what if he is not fully, or always, lucid? Does that matter if he is still making decisions that he would have made if he had remained lucid?

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      • Sorry Tess, I hit that post button too soon! What if he is not lucid and making those decisions as he would have when he was. But, he would have known to do things differently, ie bathe?

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  12. jaggh53163 says:

    The Lord gave each of us “free will”, to make our own decisions, NOT to make decisions for others. Whether we like what others decide or not, it is their choice and we should honor that. This gentleman does not want food, or help, or to be clean or anything else others want for him so they will feel better about his situation. It may sound hard, but I think his wishes should be honored. If he is of sound mind, and it sounds like he is, he knows he is going to die. He probably wishes that he had already done so. Let him die surrounded by the things that are dear to him, his possessions and his memories. Please respect his wishes.
    I would hope that if I were him, I would be allowed to make my own decisions and they would be respected, instead of having other people’s decisions forced upon me.

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    • Thank you for your feedback. And I agree with the sentiments. What if he is not of sound mind? But his decisions are still along the lines of what he has decided up to this point? We have this discussion often, about what the person wants vs. what ‘we’ (we being anyone but the person himself) think is better for him. It’s never an easy discussion. I lean towards agreeing with you. But I have also seen those who like this gentleman, wanted nothing, but when against their wills something did change: they flourished and loved the attentions and care.

      I often tell myself I wouldn’t want someone else telling me how to live.

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  13. wow it’s so sad, does he talk has anyone heard his story? i wonder what his reasons are. i truly have no answers, that’s a rock and a hard place personified. 😦

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  14. gita4elamats says:

    How about leaving him at home but not leaving him alone. I hear that he is refusing help but for e.g. ‘ Meals -on- wheels’ could still leave him a meal everyday and who knows slowly, he may respond to the kindness and accept more help… 🙂 Gentle kindness is the key, I think.

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  15. I was going to make the same point as Bikebrown. IF he is of clear mind then who are ‘we’ to tell a 99 year old man what to do. We wouldn’t do it if he was 20, 30, 40, 50.

    After everything that man has lived through, the wars, the recessions, the technological advancements and the deaths of all those around him we should not just accept his wishes, we should respect them.

    As difficult as it may be we shouldn’t have a care service that takes away freedom of choice so we can sleep easier at night. The care service should be there to offer whatever assistance is desired by the individual involved, not what is desired by us.

    That’s why the care profession can be heartbreaking. When the time eventually comes for him to pass away you should be content in the knowledge that you helped him do it his way. Even if that help means doing nothing.

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    • Steven that last line really hit home. I think we do struggle with the ‘do nothing’ sometimes. Not always, sometimes. Sometimes we know that doing nothing is exactly what we should do, and we advocate for that. But there are some situations that we just don’t know….enough. It’s certainly not anything any of us take lightly. And you are right, many things we want to do makes “us” feel better. That’s not a bad thing, some times it’s the right thing, and some times it’s the wrong thing. Thank you for the feedback.

      All of these comments echo in my head as I get ready for another day.

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    • Irish Katie says:

      I too read that last line and think … tis hard…but perhaps the right thing at times. That one sentence sums up a lot of what people are trying to say I think.

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  16. could someone subtly check in on him, just so he’s not left gone when he passes?

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  17. I say let the man be. Working in a nursing home when I was young and later a retirement community there was nothing worse than seeing someone who was forced to be there. For many people it was a great substitute for their home and they were happy with the care and companionship that it brought. Yes, he will be gone soon but hopefully they will be peaceful years for him. I think you deserve that if you make it to 99!

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  18. Viveka says:

    Colleen, this is a tough one – but I think the man has the right to live the life he wants, and maybe he want to die – maybe he feels that he has given life all that he are able to. And at an age of 99, what right do we have to change his wishes for maybe only another year.
    It seems to me that he a healthy brain and it’s his choice in the end.

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    • We sometimes wonder that when we come across situations like this. Is he ready and just waiting it out? Sometimes folks flat out tell us their ready to go. Sometimes they tell us they have more to do. Sometimes they don’t address it at all. We always want whats ‘best’ for them. Sometimes not knowing for sure what that is.

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  19. Patty B says:

    This is so sad and I agree a difficult choice for those who want to help. In the end are we helping someone like that, who know where he wants to be and live the way he wants to. At his age, maybe it would be kinder to let him live and die the way he chooses because in the end wouldn’t it be better to have made his last days nice ones? But then again as a caregiver myself my first instinct is to help him live a more fulfilled life in his last days, and then again, is it more for me or for him…very difficult.

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    • That’s the hard part, is it for him? Or me? And doing “nothing” doesn’t seem right. And doing “something” may upset him, but give him some comfort he may be too proud or stubborn to accept. Or he truly doesn’t see it as a comfort. Sometimes, there is no way to know. Thanks Patty.

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  20. Anonymous says:

    Are we trying to make him feel better or make ourselves feel better? Just saying!

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  21. cindy knoke says:

    hmmmm……are you perhaps another LCSW? There is a group of us her in blogdom lurking about. If you are, you would be lucky number 7 that I know. We met each other here through our blogs which I think amazes us all. Blogging social workers who knew? From all over the world too~

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