LETTING GO: THE DIGNITY OF RISK
by Cindy Hasz
American Reporter Correspondent
San Diego, Calif.
SAN DIEGO -- Sometimes honoring "patient rights" means you have to walk away from someone who might really need your help. Someone like the 90 year-old man who threw us all out of his house tonight.
I've just seen this man through a week of trauma and drama, which began with a fall last Monday afternoon.
I was there that day to meet a representative from an emergency alert system to install a device that this gentleman could activate if need of emergency help and unable to get to the phone. He had fallen twice in the previous week but not hurt himself. All I knew about this man after one brief visit was that he was not eating properly, drinking enough fluids and by his own admission had lost over 20 lbs. in two months. No family in the state and no one to help on a regular basis, he was at high risk for serious injury and even death if nothing was done.
As is so often the case, he didn't see it that way.
He'd just refused the emergency alert system and was walking to the kitchen to show us how independent and strong he was when he came to a complete stop in front of the refrigerator. He appeared to go blank for a brief second and started falling backwards.
Before I could cross the room to break his fall he had smashed his head against the door of the microwave cart, breaking the thick piece of wood in half. He lay on the floor, white hair covered with blood from a huge wound at the back of his head.
As a kitchen full of paramedics strapped him onto a gurney with neck immobilized and head wrapped like a mummy, he told me he thought he was ready for "that system."
Five metal staples to the head later, I brought him home from ER and had someone stay with him until he went to bed. The next day he saw his doctor who admitted him directly to the hospital for treatment of dehydration with IV fluids.
After two days of getting pumped up with fluids and electrolytes and good food, his doctor discharged him home with the understanding that he would go home with care. He grudgingly agreed and I drove him home last night as it got dark.
He couldn't wait to see his dog.
Man and dog were reunited and both made a beeline for their big lounge chair. He was home again and happy with Lhasa Apso curled up on his lap. Though feeling stronger, he was still weak on his feet. He kept protesting all through the evening that he didn't need anyone with him. This morning and through the day, the protests got more vigorous.
Two calls from his son won temporary compliance but by late this afternoon he was telling the women to go home and making it quite clear to me that he was done with having care.
Though he put it a little more colorfully than that. Frustrated, the son was ready to acquiesce to his father's demands for independence and though worried about his safety, I had no choice but to leave him. He had been a commander of a Navy ship during the WW II and still wanted, no needed, to be at the helm of his own life no matter the cost. This evening as I write this he is alone; at high risk for falling and self-neglect. His ability to take medications correctly, prepare meals and get adequate fluid remained is marginal at best. Left alone for any length of time, he's another serious fall waiting to happen.
Next time he may break a hip, or knock himself unconscious. As strange as it might sound to some, that is his right, and it is a right that even Adult Protective Services will not take away from him. As dangerous or risky as his choices seem to me tonight, to his son and no doubt to his doctor, he must be allowed the dignity of risk.
It is hard for me to let go and allow this man the freedom to make choices that might endanger his health and safety but all we as medical professionals can do is offer help. He has the absolute right to refuse it. And we must honor that right.
Family members on the other hand have more of a moral authority to press difficult decisions and even take legal control through mechanisms like a "Durable Power of Attorney for Health Care" and finances when needed. In this case it is no doubt a decision that will be forthcoming quickly. But here in the quick-changing shadowlands between independence and freedom surrendered; at the cusp of diminishing selfhood and loss of everything by which this man has defined himself, we must let an old warrior have his last stand on the bridge.
All hands will be on deck when he is ready for us.
Cindy Hasz is a nurse and writer living in San Diego. She can be reached at mailto:firstname.lastname@example.org.