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Madelaine Zadik: When the body ‘defects’ and joys diminish



Tuesday, May 06, 2014
I have been glad to see the issues of aging, death and dying, and suicide being addressed publicly. However, wishful thinking often gets in the way of true honesty about the aging process.

The reality is harsh. Often there is no way to care for someone at home and no good way to ease suffering. There’s a reason we don’t want to talk about it. The aging process, if one lives long enough, often robs us of our dignity — not being able to feed oneself, toilet oneself, dress oneself.

My mother, Ursula Zadik, died last October at age 95, after several years of slow, prolonged decline.

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She survived being hit by a train at 16, survived the Nazi Holocaust, survived breast cancer, and survived the loss of her faculties much longer than she wanted to. She had lived a very active life, hiking after knee replacement in her 70s and parasailing in her 80s.

In her 90s her body defected, yet she persevered. Mom made the most of what she could, with an amazing ability to find beauty in life, despite the fact that what she could enjoy was diminishing. Failing hearing and vision robbed her of many pleasures.

Severe osteoporosis meant fractures and pain, and limited her walking. Mom was such a survivor, she had trouble figuring out how to die.

Mom talked about wishing she would die in her sleep. She went through an awful period of severe pain. Despite what some doctors may say, modern medicine has NOT figured out how to control severe pain while still maintaining function. A cocktail of Vicodin, OxyContin and morphine turned her into a zombie, yet she was still moaning in pain.

Thankfully, Mom got through this episode, but it took several months to get the drugs out of her system and regain cognitive function.

We saw to it that Mom enjoyed as much as she was physically able, with a great deal of help at home, but she was still frustrated by her limitations. There was nothing more we could do to improve her worsening quality of life. She asked whether she should just take a whole bottle of Tylenol (I advised her that that was not a good way to die). It was painful to watch her deterioration, knowing she was conscious of what was happening to her.

A fall and more fractures led to a nursing home last July. She wasn’t happy to be there.

Yes, nursing homes could be improved, but nothing could possibly make them home.

Mom wanted to be able to go to the bathroom without having to wait for help, and she wanted to be able to wipe her own ass. She wanted to be able to take care of herself as she always had. There was nothing anyone could do to make her life such that she didn’t wish to be dead already. Had it been possible to offer her a pill so she could simply not wake up, she would have taken it.

Still, it was a beautiful autumn and Mom managed to make the most of things, spending much time sitting in the garden in the sun. She had a fabulous tan. I would see her on my way to and from work, longer on weekends. Her eyes would light up when she saw me, but she would say, “You know everyone has to expect that their parents will die.” But she wasn’t actively dying.

Mom had a DNR and a MOLST form, which still did not give her the control she wanted.

When the interview with Lee Hawkins was published (Gazette, July 30, 2013), I read it to Mom and we discussed Lee’s plan to stop eating and drinking. I told her I loved her and would miss her when she died, but would respect whatever choices she made. Not choosing that outright, she began eating less, and got frailer, weaker and more tired.

Then she questioned continuing her medications. But stopping the meds didn’t bring immediate death. She continued on for several more weeks. Fortunately, she wasn’t in much pain. She began having trouble breathing, which was scary for her. Oxygen and morphine only helped a little. One evening she announced she was going to die that night, but it took another three days as she slowly became less and less responsive.

Was it a “good death?” Would it have been easier if she could have taken that pill? I’m not sure. Let’s not pretend there are easy answers or solutions.

An excellent book I would highly recommend to anyone dealing with aging family members is “My Mother, Your Mother; Embracing ‘Slow Medicine,’ The Compassionate Approach to Caring for Your Aging Loved Ones,” by Dennis McCullough, M.D.

Madelaine Zadik of Cummington is the manager of education and outreach at the Smith College Botanic Garden.



Dignity Project detailsThe Daily Hampshire Gazette invites submissions to The Dignity Project 2014.On Tuesdays, the newspaper will present stories and essays by and about people wrestling with end-of-life decisions.Find previous stories, letters from readers, video and more for The Dignity Project 2014 in GazetteNET.com’s new Special Coverage blog located on the home page’s blog block.All in the community are welcome to submit essays for the series by email to newsroom at www.gazettenet.com, with “dignity project” in the subject line, or by writing us at the Gazette, P.O. Box 299, Northampton, MA 01061. To discuss a possible essay topic, call Laurie Loisel at 585-5253 or Editor Larry Parnass at 585-5248.