DNR

Mr P has diffusely metastatic prostate cancer. It's eating away his bones, literally. The medications fail to work anymore and he is curled around like a little 'C' of an old man. His tattoo's on his arms can nearly be mistaken for the hematoma's where blood has been drawn and destroyed his fragile old veins. His head is tiny with sparse snow white hair on it and he has bony sharp features. His voice is raspy and he has a speech impediment where his L's don't quite come out, which remind me of a cousin I love. I've been caring for him for 2 days and I will see him again tomorrow after a comfortable day at home. I think of him and remember the conversation I had with his daughter yesterday.

She doesn't want her mother involved in the discussion regarding end of life care. She, herself, can barely manage. She thinks she's protecting her mother from harm, fatal, heartbreaking, irreparable harm. Maybe she thinks her mother will quit living too if she knows her love will leave her soon. I think the woman who loved the man for so many years has a right to know - but I am not her daughter and don't know how strong nor fragile she is. It is enough for me to tell the daughter the stark reality of his condition and that she needs to consider a DNR for future hospitalizations. She must think about his suffering, his quality of life, his end. She cries harder and softer through most of our conversation, my hand rarely leaves her shoulder.

I weep openly now as I write this, because I could not yesterday. That was the time and day for me to speak clearly, make myself heard. It was not about me - this was my opportunity to help her, and him by pointing her in the direction of life as it faces death. I cannot even consider the death of my own parents, and won't until I'm forced to, like her. I told her that their decision about whether he goes to hospice or home is a matter of where he will live best, where he will be most comfortable. His days are numbered, who can care for him - and this has little to do with medicine, and all to do with love. I said, if he is to come home, what he will need is his family. And not to help him sit or eat or walk, although that may be true. They should not treat him like the sickly man that he has become, for although is this quite obviously true and hurtful to all of them - he is still, and always, will be here father. If she loves him so, then she should simply be with him the way she always has. Could he ask for anything more, if a cure is not possible.

It's true, he is dying. But for as long as he continues to die - he is alive. I hope she heard me.