The death of Karen Pautler’s father was so traumatic that she has written the story out, blow by blow, so to speak.[i]
Some of her emotions – grief and regret and pious hope – are what one would expect. The deaths of one’s parents are never easy, even when one isn’t as close to them as Karen has been to hers. Other emotions – anger and frustration – have a different source.
In May 2011, Jack Pautler was a vigorous, healthy man who was still mowing his own field. That month, however, he bruised his back badly, was given a prescription of oxycodone for the pain, and sent to a nursing home to recuperate.
At first, Jack seemed to be improving but over the next several weeks, he lost weight and energy. In hindsight, it was determined that the oxycodone, a semi-synthetic opioid that can cause debilitating appetite loss, was the culprit. The less he ate, the more malnourished and weak he became.
Obviously, had the doctors realized their patient was not tolerating his medication well, they might have withdrawn the oxycodone. As this evidently didn’t occur to them and Jack was failing fast, Karen arranged for her father to be moved from the nursing home to a hospital where, despite some hitches, he received a gastronomy feeding tube and – surprise! surprise! – improved dramatically. From this hospital, Jack was sent to an acute long-term care facility to finish his recovery.
It is important to understand that Jack had very specific wishes about the care he wished to receive and brought to these hospitals both a signed, witnessed Medical Power of Attorney document that requested Full Code and a statement, that he had also signed and had witnessed, reading:
My care providers should neither do anything nor omit anything that will cause my death. I deny the authority of any person or entity to withhold or withdraw food or water. Mechanical or artificial measures are to be used if needed to provide me food or water. Medical treatment is to be provided to remedy or relieve the symptoms of my condition.
Pretty simple and straightforward. To this, Jack also expressly told his doctors, over and over again, that he wanted to live and to get better. These statements appeared in his daily medical reports.
Karen, who had Medical Power of Attorney for her father, almost never left his side. However, she occasionally had to go home to shower and change her clothes. When she did, a friend would come to stay with Jack. On one of these occasions that Karen was briefly gone, two doctors entered the room, ordered the friend out, and conducted an evaluation in which they claimed that Jack, contrary to everything he had previously said, now wanted to have a Do Not Resuscitate (DNR) order and “to be allowed to die if death is imminent without life saving treatment.”
When Karen discovered that a DNR had been placed in her father’s file, she objected strenuously but was assured that it would only be used if Jack were put on a ventilator or if his heart stopped. He would continue to get all the medical care he had been getting.
Things were steadily improving but, in July, there was an incident in which one of Jack’s therapists caused his nose to bleed while inserting tubing down it. Blood flowed into his lungs. The matter was quickly resolved and the therapist told Karen they would no longer suction Jack’s throat using a tube through his nose. It was clear that the skin there was extremely fragile.
The following day, however, a new therapist was assigned to Jack and she resumed the nasal tracheal suction … with catastrophic results. As she attempted to forcibly insert the tubing, Jack struggled to breathe and set off a “high heart rate alarm” – that brought no outside response. After several minutes of what Karen called “useless maneuvers with the oxygen mask,” the therapist announced “I can do nothing to help him because his heart is stopping and he is Do Not Resuscitate.” She would not call anyone else to help.
It took Jack about 20 minutes to suffocate.
Karen brought her story to the Colorado Medical Board and has been left extremely dissatisfied. They found “insufficient grounds to warrant the commencement of formal disciplinary proceedings” against the attendant doctors. The therapist who inserted the tubing was investigated and placed on probation for a year, as well as ordered to take 12 hours of additional “education on therapeutic interventions.” In a climate supportive of “merciful,” hastened deaths, how could these professionals be held accountable for anything other than good intentions?
Karen’s reflection at the end of this experience are that all the documents in the world do not assure that a person will find his moral convictions respected. She warns never to allow a loved one to be given a DNR status and encourages two people, if at all possible, to be present with a patient in the hospital, acting as witnesses and advocates.
It is painful for Karen to rehearse all that she wishes she might have done to protect her father. One ought not, on top of the other burdens of heart and mind one carries at such a time, to have suspicions that a loved one has been hastened to his death.
Unfortunately, stories like Karen and Jack’s are multiplying. It seems that the more energy poured into having people articulate their “end of life wishes”, the more examples one finds that people holding traditional moral beliefs are being steamrolled under the machinery of “merciful” death.
[i] Karen Pautler, “Death: The Cure-All for the Elderly,” The Bellarmine Forum, Fall 2014;(p. 21)