TARRANT COUNTY PHYSICIAN (7)
Pauline “Look at the train,” my grandmother, Pauline, said, looking out the window
of the hospital room. “Those animals have such big heads and little bodies.”
he wasn’t alarmed by the animals
or afraid, just confused by their
dysmorphia. I humored her and
told her that I agreed; that there
were “animals” and that they did look
strange. Grandma knew I was a doctor.
She’d ask me how the doctoring was
going every time I would see her. One
time a year or two before this visit she
commented on how well I had been
eating (I promise you I had only put
on five pounds). As I write this, I am
becoming more aware of where I got
my sense of humor. A few minutes later,
down the hall, I sat next to my uncle and
across the conference room table from
my mom. The siblings were there to
hear what the doctor had to say about
Grandma’s condition. Grandma had been
Unlike my sister, I had withheld my
opinions from anyone except my mother.
I had hoped they could keep Grandma at
home, and they tried so hard to do that,
but it just wasn’t possible. It turns out that
the very thing my grandma said she never
wanted—going to a nursing home—is
exactly what had to happen. She had
worked at the nursing home there in
town, as did I years earlier. In fact, at 19,
I spent the summer with my mom, who
had moved back to Texas, and worked
the night shift at “Leisure Lodge,” mainly
giving bed baths. Now Grandma was the
one getting bed baths after an operation
left her unable to bear her own weight.
This was her sixth year there and she
by Angela Self, MD
without being “hospice appropriate”?
Apparently, it was appropriate for
Grandma. She was declining, eating
less, being more withdrawn, and
getting repeated infections complete
with hallucinations. It was not long after
that meeting with the doctor in that big
conference room in that small hospital
that Grandma passed from time to
I wish I had shared my opinion on this
topic years earlier, even with my grandma.
I wish I had visited her more, asked her
more questions about her life and the
struggles of raising kids and running a
farm, even when her husband wasn’t
there to help. I wish I had suggested to
anyone that they talk to Grandma about
whether she wanted to keep going in and
out of the hospital. It’s easy to discuss
wishes about being on “life support,” but
what about overall care and treatment?
I’m an advocate for the rights of the
elderly—their right to receive hospice
care or to refuse it. I truly am glad that my
grandmother got it in the end and that
all the kids could see that the medication
was not harming her but allowing her
to be comfortable and pass in peace.
You might wonder what illness was so
grave that it would take a young woman
of 92 (that’s actually a little young for the
women in my family). She did not have
cancer or diabetes or even heart disease.
My grandma died from a UTI after being
placed on hospice for chronic urinary tract
had never stopped longing for home. My
aunts and uncles visited her almost daily.
She had photos of all the grandkids on
the wall next to her bed. She had snacks
and candy nearby at all times. There was
never complete agreement amongst the
siblings about the nursing home situation,
only that they all loved Grandma and
wanted her to be safe and not suffer.
Hospice? Were we really having
a conversation about hospice? Was
Grandma really that close to the end?
The doctor said that these repeated
hospitalizations were hard on Grandma
for the simple fact that the veins were
getting harder to find and that starting
an IV and drawing labs were painful.
I have had so many of these types of
conversations with patients and family
members, but at this moment it made no
sense. There we sat in a room holding
the power of life and death. I was numb.
While preparing to write this I asked my
mom what my grandmother wanted
and why hadn’t she made her end of life
wishes clear. No one really wanted to
talk to her about how she wanted to die,
though we all knew she was ready to go.
She had lost Grandpa years earlier and
she was ready to go meet him and others
up in the sky. Grandpa had been in and
out of the VA and succumbed to a bout
of heart failure, likely secondary to issues
stemming from WWII. Grandpa did not
get the benefit of hospice, and frankly, I
don’t know that it was ever appropriate
for him. Is it possible that some of us die
I’m an advocate for the rights of the elderly—
their right to receive hospice care or to refuse it. “