Friday, May 8, 2009

Tragic Ending

Five weeks ago, my 91 year old grandfather fell into a coma, after being revived by the paramedics for a total of seven times, on the way to the hospital. My grandfather, who believed that Death would somehow forget him, had adamantly refused to sign a DNR, and as a consequence, arrived brain dead. Because my mother and her two sisters believe in the role of the halacha (sometimes over common sense), their father was immediately placed on life support and a feeding tube.

In addition to managing my father's business, my mother visits my grandfather every day, twice a day in the hospital. She tells me that it is clear hat he is unaware of his surroundings; that his physical situation remains stable only with the benefit of the various machines that have taken over the function of his brain and parasympathetic system.

This past week, in an attempt to move my grandfather into a Chronic Care Facility, the doctor removed the breathing tube in the presence of my mother and one of my aunts. According to my mother, my grandfather began gasping for breath, and while he may have expired soon afterwards, the guilt and perceived immorality of the situation overtook them. The breathing tube was returned, and it seems that my grandfather must now spend the rest of his days as a vegetable, in the highest cost situation possible. His heart is strong, and he could very well "live" this way for another five years.

In Judaism, a traditional blessing is given, "May you live to 120." Not so in this case, I know that my grandfather could not have imagined his full life culminating in this tragic never-ending end.

The family knew at some point that the home in Providence would have to be cleaned out and sold, with the death of my grandmother seven years ago and the subsequent deterioration of my grandfather's health. Now not only will the house be sold as soon as possible, regardless of the poor showing of the current housing market, but all his carefully planned stocks and retirement assets will be liquidated, to pay for this care.

It doesn't stop there. Medicaid will only pay their share when it can be shown that my grandfather has essentially become a pauper. This includes gifts he has give to his daughters and eleven grandchildren in the past five years. My parents, who themselves are struggling with a mortgage, running a business and sending my youngest brother through college, may have to sell their home and leave the community in which they have lived and actively contributed for the last 23 years, in order to pay off their portion of the gifts to be returned.

The thought sends me spinning: because my grandfather was not allowed to die a simple death, it could bankrupt my immediate and extended family. This is a case of mismanagement by both the medical establishment and the Orthodox Rabbis who did my family no favors by insisting upon extreme measures. Even worse, the same government that allows a parent to give tax free gifts has a cleverly placed back door in the program, to take it away with a vengeance.

My grandparents, founders of the Orthodox Jewish community in Providence, Rhode Island, raised their family and planned for their financial future. My grandfather, and Optometrist by training, worked until his mid-80's, until he was physically unable to get to his office.

That is the harshest irony in this whole story: A workaholic by nature, my grandfather sacrificed much in his primary role as breadwinner, concerned with providing for his family and community. He often said that if it had not been for the Shabbat, he would have worked seven days a week, and he would not have spent any time at all with his family. At the end of his life, his mind is now literally disconnected from his body, and all those years of proving his manhood as a doctor will be taken away in an instant.

We live in an age of "miracle" medicine, where life is prolonged without having the resources in place to properly care for our elderly, and by extension, the sandwich generation left with the burden, both financial and emotional.

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