The meeting with the doctors began as expected. How many of these meetings had we had over the years? Enough to render us fluent in the medical lingo as it pertains to psychiatric patients afflicted with paranoid delusional disorder. Or was it schizo-effective disorder? At one time, with absolute certainty it had been bipolar, manic-depressive disorder. Regardless of the see-sawing diagnoses, what made this particular meeting unique was the physiological determination they were oh-so-diplomatically attempting to impart to us. Dimentia, the master puppeteer manipulating my sister’s life for so long, had been demoted to the level of lesser demon, ceding position as leader of the band, usurped by cirrhosis. The denouement of her story, it seemed, would no longer be determined by a debilitating psychiatric disorder. The maestro may well conduct the opus with a baton forged of dissociative states but the composer of the final movement was the rotting liver she had inflicted upon herself with alcohol.
We had been informed, in previous conferences with medical professionals, that drugs and alcohol were not only the catalysts that unleashed her mental disorder but they whipped it into a frenzy. What did any of this matter in the end I wondered? No one, no treatment could save her. Not even she herself, whose very existence was being tipped down the drain like stale beer, could fight the dual forces of addiction and mental illness. Was there any point, essentially, in discerning the medical etiology? How could we ever know whether a healthy life without alcohol and drugs would have produced a healthy mind? Perhaps this was always going to be her final descent, or ascent if you are more spiritually inclined.
As I pondered these questions I stared, with great intensity, at my unclipped toe nails – chipped, red nail polish not quite covering them as current good form required. I regarded each toe, individually rating them on a comparative scale to ascertain which of them was most in contravention of seemliness. This particularly dissatisfying survey concluded, I next considered my shoes, sandals really. They were supposed to be white… had once been white but now were a sullen grey, pocked with black splotches here and there. The leather was, indiscreetly, trying its damndest to separate from the base of the shoe. I flicked my toes, to encourage further deterioration of the shoe. I did it again and again, harder with each twitch. It was entirely pleasurable and fulfilling. I wished my shoes would fall apart right there and then. I sensed that the doctors, from their aeries high on the face of the societal cliff, had already pegged me much further down the evolutionary scale. Tatty clothing and frizzy hair has a propensity to do that. It would never occur to them, I was convinced, that I might actually have a very fine mind if not so fine morals and history.
It was true, I had left home in a hurry to get to this meeting but appearances aren’t always a reflection of the person, contrary to my mother’s preaching. Didn’t it, in fact, prove how much I cared for the dissolving mass of humanity formerly known as my sister? Didn’t the fact that I left my home with no regard to my external affect, to attend to her well-being, prove that I was a person of substance with a caring heart? Or was it more likely the reverse? I did these things in an effort to reclaim a modicum of morality and philanthropy long lost in the rush of life? Whatever! I had dashed out without brushing my teeth or so much as a glance at a mirror (although the latter may have been more for my benefit than anyone else’s).
“We drained 7 litres of fluid from her abdomen yesterday and even though there is a substantial amount still left we didn’t want to risk continuing due to the risk of infection”, the impossibly young, gorgeous doctor was explaining as I continued twirling my shoe on the end of my unsightly toes. I intensified my focus on this activity to escape the envy that gurgled up through my awareness. Envy that some other woman had managed to snag this man. A fact blaringly attested to by his wedding ring and, a fact that was clearly intended to emphasize the idiocy of my own marriage.
“We will wait at least another week and then reassess the situation before deciding whether to remove more”, he finished.
“7 litres of fluid” I thought, “that’s like 7 huge bottles of Coke. My son could drink one bottle, at least, in one sitting but imagine 7 bottles!” Outwardly, though, I continued focussing on my feet. I knew this doctor had noticed my podiatric condition and was politely ignoring it.
“Because of her cirrhosis we’ve had to reconsider the medication we’ve been prescribing for the psychosis and paranoia. We are going to take her off clozapine and put her on…” (Some long-ass named drug that I can’t recall let alone pronounce) “Clozapine is very hard on the liver and we don’t want to exacerbate the physical repercussions any more than we have to. “
“What about her incessant itching and scratching?” my mother asked, her focus never wavering from the doctor giving instruction. The incarnation of caring, really caring, was my mother. Running out of the house without care for personal hygiene was certainly no sign-post of caring, not when illuminated by the intensity of this woman’s gaze and the sincerity of her voice.
“That is a symptom of her deteriorating liver. Fluid retention, jaundice, dementia and the itching. We can give her some medication that will reduce the itching and make her more comfortable”.
He paused for a moment to let this sink in. The silence became almost visible, I could just about see it throbbing in the nether.
“At this point, even though she is in palliative care we need to discuss your options. I know you have power of attorney over her medical needs, right?” the older doctor, filaments of concern webbing across his face, questioned my mother. She nodded in silent reply.
“Well, you have some decisions to make. As things stand at the moment the only medical treatment we are giving her is to make her comfortable, like removing the fluid from her abdomen. But we need to discuss what you would like us to do if any her of symptoms become acutely threatening. Do you want us to resuscitate? “ His voice was almost hypnotic – calm, thoughtful, and resonant with compassion. His deep brown eyes were bracketed by bushy eyebrows which, although in need of a trim, cushioned his sharp gaze. Had I misjudged this man? Was he as riddled with self-doubt and insecurity as I? The spark of humanity, a quasar at the center of his being? What a lovely human being. This man, although discussing the details of my sister’s imminent death, had managed to lull me into a sense of tranquility and comfort as if discussing the sunset shimmering on the coastal waters of Bora Bora.
They had shamed me, these doctors, these selfless men. It made me curl my toes under and try to hide my feet. I considered indulging in self-righteous anger for this trespass but was loathe to let the warm feeling pass. I could save my anger for my husband…he always did something to warrant it…
“I don’t want you to resuscitate her”, my mother’s firm voice barreled through my reverie. “There really isn’t any point in prolonging her suffering”. I could see the tears forming in the corners of her eyes and I had to turn away. The most tragic decision a parent ever would have to make had befallen her and I didn’t want to intensify her suffering.
And so, with that, my sister became a DO NOT RESUSCITATE.