Sunday, January 31, 2010

No Matter How Hard

This is a beautiful piece I saw on Cross-Currents for those that don't read it, I chose to share it with you:

The article begins with the author’s many trips back and forth to the hospital during her father’s long, drawn-out illness; how she was tormented repeatedly by what appeared to be his imminent demise, death lingering around the corner, tauntingly, slipping maddeningly in and out of sight; and then, at last, how the final moments seem to arrive.
…[that] my father’s heart is weak, his kidneys are failing and his lungs are filling with fluid. For the second time in six months, he needs to have a tube inserted in his windpipe.

I nod, waiting for him to continue listing procedures and tests. Instead, he takes a small step back from the gurney and asks, “Does your father have a living will?”

I freeze. No emergency room doctor has asked me this before. I answer, evenly, yes. “Do you have durable power of attorney?” Yes.

Visibly relieved, he looks me in the eye and gently but pointedly asks: “Does your father want us to employ extreme measures” — he pauses one heartbeat for emphasis — “knowing that he is not likely to improve?” The two nurses flanking the doctor look at me kindly.

I smother my rising panic. I must stay calm. I need to think. The doctor has given us an opening, a chance to consider our options.

I know what I want: I want to stop the insane cycle of hospitalizations and heroic life-saving treatments. It is not helping my father. He is getting sicker. He is dying. And I am exhausted beyond belief. I have no energy for family or friends, and my career has suffered. I want my life back.

I am acutely tempted to answer, “Of course not — my father would not want heroic measures.” But I hesitate because I know it might not be true. In the past, he has wanted everything possible done. This night is different, but I do not know if his answer would be different.

I look at my father. It is hard to tell if he is conscious. No one else is looking at my father. Everyone is watching me closely.

Finally, I say out loud the only thing I know to be true. “In the past, my father has asked that everything possible be done.”

Then I bend over my father and ask him in a clear, strong voice: “Daddy, do you want to be intubated again? Squeeze my hand if you want to be intubated.” I wait, but he does not squeeze. Instead, he surprises us all by nodding his head. He is weak, but the nod is unmistakable.

One nurse grunts and rolls her eyes dramatically. The other mutters, “Oh, brother — here we go again,” and shoves a stainless steel instrument cart closer to the gurney. The doctor, more professional, remains impassive as he suggests I leave the room. “It is difficult to watch this procedure. Most patients struggle and flail, so we will have to use restraints.”

Yes, I know. I kiss my father on the cheek, tell him I will be back soon and head to the waiting room.

What the doctor and nurses do not know, what I hesitate to admit even to myself, is that I almost gave them the answer they wanted: the reasonable one. But I would have been terribly wrong.

My father never really recovered. He could never again breathe without a respirator, he never left the hospital bed, and he eventually needed dialysis and a feeding tube. Six months later he died of heart failure.

I suppose my father’s decision was a mistake. But it was his mistake to make, not mine. My role was to support my father, no matter what, and to tell the truth, no matter how hard.


  1. It's inappropriate to credit this to Cross-Currents. It appeared in the NEW YORK TIMES on Tuesday.

  2. Tesyaa,
    Sorry, but you are incorrect. The article filed with Cross-Currents is not what was printed in the Times. The Cross-Currents piece contains that Times' article but more in addition to it, thereby making it a perfectly legitimate source on its own.

    The rule of attribution is that you give credit to the source you actually use when excerpting material, regardless of whether or not that piece contains material that has been printed elsewhere. You do so because 1)there may be additional material in the source you are quoting, as is the case here; 2) there may be information that was deleted from the original publication; three there may have been grammatical/sentence structure changes that were made, such as correcting a spelling of a word.

  3. ProfK, thanks for the update. And the Cross Currents article refers to the NYT. Does Cross Currents need permission to reprint the article?

  4. Tesyaa,
    If the author of the Cross Currents piece reprinted the complete NYT article verbatim within her piece without any of the additional material she added, she would have needed to get permission from the NYT to do so. The Fair Use Doctrine governs how much of any printed, copyrighted piece may be used in someone else's writing. But the Doctrine is a bit fuzzy in some areas. As a college instructor I could have duplicated the Times piece for my classes this term, with credit given to the Times, but without having to ask for permission to do so. If I wanted to use the exact same piece again next term I'd be heading into a grey area. One of the issues is how much of an original work is copied in a secondary printing. I suppose you could say that the NYT piece used in the Cross-Currents piece represents a minute part of the total Tuesday edition of the Times, and therefore it might not violate fair use. I'm not sure, regarding newspapers, if a single article is considered a free standing piece or is included in the overall edition. Something for the legal departments to argue out.

  5. It saddens me that the author of the article seems to have come to the conclusion that his decision was a mistake.

    Who knows what zechuyos his father gained during his final months of life?

    It is *certainly* obvious that this son gained many MANY zechuyos by tending daily during those six months to his father's needs. (Kabed es Avicha V'es Imecha LMA'AN YARICHUN YOMECHO - THIS SON MAY VERY WELL HAVE EXTENDED HIS OWN LIFE BY ANSWERING THE DOCTOR AS HE DID!!!)

  6. ProfK; For the fair use doctrine, you look at each article separately, not the whole newspaper. Further, I don't think fair use allows cutting and pasting an entire article. The proper way to do it is provide the link, not a wholesale cut and paste.

  7. Anon 9:43, but it's the New York Times! They're evil and liberal! We can use their material in whatever way we want to prove out points about them!

  8. Wow...

    I agree with G6. Sad that it's viewed as a mistake.

  9. Does halacha require that we take proactive heroic measures such as tracheotomies, even if the patient doesn't want them? I really don't know...

  10. I learned that if patient want to die but he must take medicine to get better because you are not allowed to prevent yourself that might help you out. BUT He is allowed to pray G-d that his medicine didn't work.

  11. tesyaa, i did not see the Times article, i saw cross-currents.

    As to the Halachic nature of the question, consult a competent rabbi, like anything else in halacha