Murder By Natural Causes

Fran has become combative. It is my belief that her eighty-five-year-old mind has fought its way through the fog of Fentenyl and Lorazepam to the realization that she is being slowly, legally murdered by her own daughter.

I saw Fran this morning. She has been held prisoner in her hospital bed for eight weeks now, and has somehow become a part of it. On a dispassionate, detached level, talking to Fran has become the act of speaking to a percale sheet with eyes and a mouth. “Please get me up,” the sheet begged. “Is there a reason that I can’t get up?”

Sick of lying to her, I took Fran’s hand. “Sandra won’t allow it,” I told her. “Please ask Sandra why you can’t get up.”

“Why can’t I get up, Sandra?” Now the child instead of the mother, Fran’s voice was pleading in complete role-reversal. “Please, Sandra?”

Fran’s only child gives her a sympathetic half-smile. “Now, Mom,” Sandra coos to her mother. “Remember when we fell? I can’t take the chance on you getting hurt!”

Sandra refuses to allow Fran to be helped up into the overstuffed chair beside her bed, or even to sit on the edge of the bed and dangle her feet. Sandra knows that Fran’s muscles will atrophy, her lungs will fill with secretions from immobility and her overall condition will deteriorate more rapidly than if she were allowed to sit up. Sandra is a nurse.

Sandra lovingly brushes the damp hair back form Fran’s forehead, speaking to her softly. “Mom, you’re dying. It’s okay to go. I’ll miss you, but it’s just your time, that’s all.”

I wanted to throw up from the nauseating display of feigned love and acceptance. Sandra has decided that it is Fran’s time to die. God has not decided this, and most definitely Fran hadn’t had a thought of dying until three months ago, when Sandra decided that it was time to put Fran on Hospice services.

Broke after losing her job, Sandra had moved from out-of-state to her mother’s house a year and a half ago. Then, three months ago, she had made a doctor’s appointment for Fran, wrangling a “six months or less” prognosis required for Hospice care by browbeating a spineless doctor. She began calling him at all hours of the day and night about Fran’s “pain” from osteoarthritis, and finally succeeded in obtaining prescriptions for powerful narcotics and tranquilizers to wear Fran down. Fran had been taken 400 mg. of Ibuprophen for years, and, in reality, could have probably had her pain relieved simply by doubling the dose.

The next step was the Foley catheter placement. Sandra decided that Fran should not get out of bed to go to the bathroom even though Fran was fully continent. Foley catheters are an invaluable tool in many cases, but it is common knowledge that Foleys create a breeding ground for infection. Infection in the elderly can pave the way to sepsis, a life-threatening condition. Hospice will treat some infections, but not in Fran’s case; Sandra keeps referring to Fran’s Living Will and the fact that Fran “does not want her life prolonged.” The physician, along with the Hospice staff, is now between a rock and a hard place.

When Angel Team was first called about Fran’s case, I immediately made an appointment for a home care evaluation. I had been told that she was a Hospice patient, and I was pleasantly surprised to find Fran to be a strong, healthy woman with no apparent signs of dementia. The day that I did her intake, she was walking around her house assisted by a walker. An oxygen condenser, with a curled, twenty-foot tube lying loosely on top, stood silently in the bedroom.

Not yet knowing the circumstances, I questioned Sandra about the Hospice diagnosis. “Emphysema,” she flatly stated. “Mom used to smoke.”

By no means am I a doctor, but I, myself, have more respiratory distress than did Miss Fran had on the day of her intake for our services. I have seen people dying of emphysema – the struggle for every breath and fight for oxygen is a terrible suffering. The breastbone sometimes becomes deformed into a pushed-out position because of the fight for breath. Fran exhibited none of the symptoms that I have witnessed in those dying of emphysema, and, now, three months later, still does not exhibit respiratory symptoms.

It is a lovely, crisp September morning, cool for Arizona this time of the year. There are two coveys of quail wandering the neighborhood, and the roses falling over patio walls have not even begun to wither. How I wish I could put a sweater on Miss Fran and walk her around the block in a wheelchair! The wheelchair sits in the corner of the bedroom, never used, and never will be used. Sandra will have her way and Fran will not leave this room; indeed, will not leave her bed – until she slips her earthly bonds and flies to Heaven’s Shore.

When Sandra moved here to “take care of” Fran, Fran was still driving her car and playing at least nine holes of golf a week. Over the past not-quite two years, Fran’s bank account (with Sandra’s name added as signer), along with her athletic good health, has been in steady decline. All that is left is the frail, white sheet-person begging to sit up, the house and a sizable trust that will not be available until Fran’s death.

And so, I again find myself in a spiritually unenviable position. I can pull my caregivers out of Fran’s home and detach myself, or; stay, provide the best of care and endure the wrongfulness of it all. The reins are in Sandra’s hands, and she is driving the stagecoach off the mountain.