Why Is It So Hard to Let Go?

Death and love are the two wings that bear the good man to heaven. ~Michelangelo

Last week, I learned that my 90-year-old aunt was in the hospital with pneumonia and sepsis. This is her second admission in a little less than six months, and she is not doing well. According to her daughter, she is unable to sit unassisted and can barely speak. And while she does have a DNR order in place, the family has been unable to agree on whether or not to call in hospice. So, like far too many elderly people at the end of their lives, she is at the mercy of a health care team who — in the absence of clear direction from the family to do otherwise — views every hospitalization as a “full court press.”

It’s so terribly sad, and so wasteful. My aunt could be at home in her own bed, cared for by the people who love her and a knowledgeable hospice team. But because some of her children think hospice means “giving up,” she will likely die in the hospital — the very place she doesn’t want to be. And the healthcare system will spend tens of thousands of dollars on care she doesn’t want that will do nothing to improve her quality of life, but will almost certainly prolong her death.

I feel very sad for my aunt and her family. But on a macro level, I am also asking myself, and not for the first time, “How on earth did we get here?” How did our thinking and priorities become so skewed that so many of us — good people with loving hearts — come to think of death as a medical failure rather than a natural part of life? How did we become so convinced that we must do everything we can to prolong every person’s life at any cost? Why do we find it so difficult to let go?

Credit: Liz West via Flickr

I’ve thought about this a lot. And I think the answer traces back to a singular event — the invention in 1960 of cardiopulmonary resuscitation, or CPR. Before then, people who died, either in the hospital or at home, simply died. Drowning victims were sometimes revived with rescue breathing (a technique that was developed only a few years earlier, in 1956). But when a person’s heart stopped, there was no turning back the clock.

But everything changed with the invention of CPR. Suddenly, reviving people after a cardiac arrest became the standard of care. It didn’t even seem to matter that the procedure was a dismal failure the vast majority of the time. (Even today, 60 years later, only about 8 percent of people who receive CPR survive long enough to be discharged from the hospital.) Doctors now had the ability to bring back the dead, and they were determined to use it. And so a whole new branch of medicine and a whole new approach to caring for the very ill was born.

At the time, it must have seemed like miraculous progress. But looking back on it with 20-20 hindsight, it seems like we opened a new and equally horrifying Pandora’s Box. Because now we have entered an era where the medical paradigm has shifted from helping people live to refusing to allow them to die.

Last month, the mother of a dear friend of mine died. I don’t know what was “wrong” with her, other than that she was old and frail and it was her time to go. And, to be honest, I had not talked to my friend in a while. But she posted on Facebook that she was going to Tennessee to be with her mom as her life came to an end. And then she posted many photos of mother on her deathbed, her children gathered around her and her beloved cat snuggled on her lap. And I thought to myself, “What a perfect way to end a life.” It was excruciating for her family, certainly. It always is. But if was beautiful too. They were all working together to help their mom cross over, making the path easier in any way they could.

I wish I could give that gift to my aunt. I wish I could give it to everyone whose well-meaning family simply can’t let go. But I think it is going to take a long time and a major change in the way we think for that wish to come true. 

About Kathleen

Each month Kathleen Clohessy, R.N., offers a new perspective on living with a terminal illness. Kathleen comes to SevenPonds with 25 years experience as a registered nurse caring for families and children facing life-threatening illness. She began her career in the Pediatric Intensive Care Unit at Nassau County Medical Center in New York. After relocating to California, she spent 15 years as an R.N. and Assistant Nurse Manager at the Pediatric Oncology & Bone Marrow Transplant Unit at Lucille Salter Packard Children’s Hospital at Stanford. She uses her knowledge and expertise to enlighten our readers about the challenges associated with chronic illness and its effects on family relationships.