“How much do you love me?,” asked my wife. It was code for, “I want to bring mother home to live with us.”
Alice was 93 years old. She had been in an assisted living home in California for two years. Now, her dementia had progressed and, even though she used a walker, she was wandering out of the facility. She needed to be in a locked ward. The assisted living home was nice; the locked ward was not. I gave in. Mother came to live with us in Colorado.
We had an early snowstorm in October. She was thrilled. She had not seen snow since she moved from Pennsylvania, over 60 years ago. Still, there was a period of adjustment.
On Christmas Eve, it snowed again. Alice wanted to go outside again to see the snow. My wife held on to her. There were two steps. Alice made it down the first step. The walker slipped out from under her on the second step. She went down. In medical terms, it was called a low-impact fall. She broke her hip.
Alice had surgery and went home on the third day. The outlook was not good. Up to one-third of the elderly who suffer a low-impact fracture die within a year. The doctor suggested hospice. We decided to give it a try.
The hospice nurse came and evaluated Alice. Because Alice spoke more than six words and because she had not lost 10 percent of her prior weight — which was 88 pounds soaking wet — the nurse was not sure that Alice qualified. But she was willing to consider a month-long trial.
My wife had cared for her mother by herself up to then, had changed her, bathed her, and turned her so she did not get bed sores. Hospice offered no benefits there. Hospice did offer two benefits we could not provide: respite care and the right to die at home without the need to call 911. But hospice had a drawback: With its social workers, chaplains, aides and nurses, all coming and going throughout the day, hospice was intrusive on our privacy. And what was the point, if she did not qualify? We canceled hospice.
Alice did not do well after surgery. My wife and I made funeral arrangements. I also called the coroner. I said I was a physician licensed in the state of California. The coroner explained the law. In Colorado, when a patient dies at home and is not under hospice, the procedure is to call 911.
When Alice passed away, I called 911. The operator asked what my emergency was. I told her that my 93-year-old mother-in-law, who had a do-not-resuscitate directive, had died. She asked how I knew. I said she had no pulse, no spontaneous respirations, fixed and dilated pupils, and no corneal reflex. I added that I was an out-of-state physician.
I explained my emergency was really not an emergency, in case there was a real emergency elsewhere. The operator said the paramedics were on the way.
The sheriff arrived first. Next came another county employee. Then came a firefighter who called a physician to confirm the death. After that came the deputy who was covering our area but had been called away to another emergency. Last came the coroner.
The deputy took photos. The coroner made his inspection. The sheriff stayed throughout. About four hours elapsed from the time I made the 911 call to the time the coroner released the body. The sheriff, the deputy, the fireman, and the coroner still had to write their reports.
We talked about the use of county funds. Don’t get me wrong; I’m grateful they came. I’m grateful they did not use sirens. I’m grateful they were solicitous. Still, with tight budgets and all, one officer would have sufficed. And Alice, in death, would have had more dignity.
Mark A. Ruszczycky lives in Mead.
