Dr. Vincent DeGennaro Jr. ’02 | April 10, 2019
He struggled to breathe, progressing from deep breaths with wet sounds reverberating in his lungs, to guppy breathing — opening the mouth like a fish, contorting the entire face. His heart rate slowly decreased, from 150 beats a minute — a pace attempting to keep up with the oxygen demands of the body — to 50 beats to 40 beats to that which is incompatible with life. The nurse pushed a tiny dose of morphine to ease the air hunger, the sensation we experience as the brain becomes deprived of oxygen.
The old man, having lived for years through the slow decline of dementia, had wanted to die at home. Even with his brain clouded by the tangled proteins of Alzheimer’s, he understood and verbalized the opinion every time his wife or daughter asked him — even telling his family that he would never forgive them if they placed him in a nursing home. But Mr. Begay’s family was not present at his bedside when he came under our care that day. We called them as his condition declined, and they headed toward the hospital, a journey that would likely take an hour across the vast distances of Navajo Nation. We worked to stall the inevitable: giving every medicine we could; performing maneuvers to increase his oxygenation; everything, short of the “heroic measures” of life support that he and his family had sensibly declined.
Dementia patients do not pass from dementia in the end, but from malnutrition, dehydration or infection. These natural outcomes result from a brain that no longer feels hunger or thirst, does not recall how or when to swallow food. He may have choked on his dinner one night and had a traumatic death. If he had passed at home, the 12-year-old great-grandson who cared for him daily would have watched, however it unfolded.
Watching Mr. Begay struggle, I recalled my grandfather. When I was a junior in high school, I shared my bedroom with my grandfather as he slipped into dementia. I slept on the top bunk, listening as he had nightmares, sometimes pounding the walls with his fists. Eventually, his need for round-the-clock care escalated beyond what we could provide, and the family elected to place him in a nursing home. He retained the physical stature that had made him a terror on the football field — even punching a police officer who came to collect him when he escaped the nursing home — but failing teeth led him to be placed on a pureed diet. Somebody at the nursing home decided to feed him a pork chop, ending his life that night. An abrupt and undoubtedly merciful end to a several-year decline, but nobody in our family witnessed the event.
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