DIFFICULT JUDGMENT CALLS
Factors to Consider

If our parents live long enough, there will no doubt be times when we are–or will be–hesitant to have them experience more misery and/or pain due to unpleasant procedures. But it happens. And if we/they are responsible, the memories can fill us with later regret: the wish-we/they-had-done-differently kind of memories.

To begin, it helps to remember we aren’t perfect. Most of us are lay people. We act out of love, concern, caring and compassion or what people we respect suggest. That’s emotion or instinct. Even when presented with facts and solid information we can make misjudgments…as can older people.

In the case of both my parents, there are things I wish had been different. Sr. Advisor R, my m-i-l, said several times there were things she wished she had done differently. For Leo, well-researched “more” worked. For my Uncle Harry, possibly not understanding long-term implications, “less” didn’t. Let’s look at some examples, as we try to make the best decisions to help parents age well.
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Face: “You should see your Dad,” my older cousin cautioned via telephone, the day before I was flying out west to see him. “He had some skin cancers removed from his face–he’s really a mess.”

I couldn’t ignore the many discolored spots on Dad’s face when I arrived at his home, the home I’d grown up in. Dad’s longtime dermatologist had taken many biopsies over the years, probably because Dad spent many winters in the desert. Those basel cells kept appearing–in spite of the fact Dad always wore his cute hat to cover and shade his balding head and face.

Now 90+ years-old, driving, and still going by himself to the dermatologist, he’d stopped questioning doctors about procedures ((he always questioned when younger). Family members wondered why such an extensive procedure was done on his face. It had to be painful. Dad’s face looked awful for a while; but what was done, was done…..and the pathologist found no cancers.

Teeth: Then there was the tooth. Dad was diligent about keeping his teeth in good shape. One tooth suddenly broke off (Sr. Advisor R also experienced that) and his longtime dentist did a simple “fix”. I was in town and went with Dad to the broken-tooth appointment. The dentist knew Dad well. I think Dad’s age and good mind made him a favorite patient.

At that visit we learned there was a potential problem with another tooth It wasn’t bothering Dad “but it could cause infection leading to serious problems…No rush, but it should come out,” said the dentist.  Dad wouldn’t miss it.

I forgot about it–only to be reminded months later by my brother, after Dad returned from his semi-annual dental checkup. My brother, who didn’t focus much on Dad’s health, wondered how necessary a major extraction was. (I was surprised–and happy–that he was paying attention.) Dad was 93 and had developed serious kidney problems. That was more pressing than teeth, my brother thought as the extraction appointment neared. Should he cancel it?

We both agreed “cancel it for now.”  This was not the time for more based on previous information. When extraction was first suggested I asked the dentist what would happen if we waited and I remembered the infected-tooth dangers etc. information. Older people don’t need avoidable infections. But how imminent was infection? Dad died of kidney failure at 94 1/2, with all of his teeth (and no infections).
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Mammograms: Sr. Advisor R, who always found mammograms unpleasant and painful, in her late 80’s let everyone know there would be no more mammograms. She’d already decided if the mammogram showed signs of cancer she’d do nothing, so why bother? She died at 101–of old age as far as we know.

Heart: And then there’s Leo, a high-functioning, high energy, octogenarian who, in his mid-80’s, was still flying around the country on business. He knew he would need heart surgery and decided to do it while he was still healthy enough to have good odds of getting through it without problems. He interviewed every specialist in NYC who would operate on someone his age, had the surgery, and is still remarkable 6-8 years later. Careful research and doing more at a certain age worked.

Prostate Cancer: My Uncle Harry was the youngest of Dad’s siblings. All were born on a farm, strong, and healthy for many years. Dad was the one they turned to for advice (the one will the college degree). Yet no one told Dad when Uncle Harry was first diagnosed with prostate cancer. Indeed, Dad expected all siblings would reach their 90th birthdays. Uncle Harry’s prostate cancer killed him decades later and was a complete surprise to Dad. The story (from Dad): Uncle Harry was initially told prostate cancer was slow growing and he could die before it impacted his life. Did he never think to follow up? Was not doing more caused by denial? ignorance?

Bottom line: Challenging situations should remind us that serious thought needs to accompany the decision to do more–or less–especially when it comes to health issues. Doctors are on the front line and their opinions are of extreme importance in helping parents age well. And sometimes the decision to do more needs to be given more attention than we might think. Asking the questions, getting all the information at our disposal, and talking with our parents about the consequences makes sense.

As Grandma used to say when we try our best: “Angels can do no more.”