What Are We Going To Do With Dad?

From my years as a geriatrician and now as the son of an "old old" man, I recognize that there is one inescapable truth: Our parents will become our children if they live long enough. Perhaps if we looked on our elderly in this way, we would be kinder to them.

I don't know what else to do for Dad at this moment, but I can imagine what is likely to happen to him if he does not die in his sleep (a heaven-sent coup de grace that I know, from long experience, is unlikely to occur). One day I will get a frantic call from my mother that my father is on the floor and crying out in terrible pain. I will race over there. I will find that one of his legs is shortened and externally rotated. His hip is broken.

I will call my brother and tell him all the reasons why we should not send him to the hospital: He might not recover from the surgery -- indeed, he might die on the table, given his bad heart. If he does survive, he will spend days in the ICU, probably on a respirator. At best he will end up in a nursing home, bedridden, at the mercy of overworked, underpaid aides. He will descend deeper into disorientation, require medications to keep him from harming himself, and die anyway in a few months -- or perhaps a year or two if he is unfortunate and the care is better than average.

My brother will hear my mother crying and my father hollering. He will feel guilty that he is not there with me. He will remember the time Dad took us on a vacation to Whiteface Mountain in the Adirondacks, and we all huddled on the swinging bridge in the mist, as the Ausable River roared through High Falls Gorge. Then he will say, "Maybe it won't be as bad as you think. Maybe we can set up a hospital bed in his room, and it won't take much to alter the shower to accommodate a wheelchair." There will be a moment of silence. He'll say: "I don't know. You're the doctor. What do you think we should do?"

I do not tell him that often, in fitful sleep, I dream that when the time comes, I go to my father's bed, quietly fill a syringe with morphine and stroke his arm as I tie the tourniquet. I tell him I love him and what a good father he has been to me as I slip the needle into his antecubital vein. Then I say how much I will miss him and goodbye, Dad, goodbye, as I push the contents into his bloodstream. In this dream I tell my mother and my brother that he has gone peacefully in his sleep.

Yet I have not until now given voice to this dream because I know, in the end, I could never do this. Not to my demented, suffering father. Not to anyone. I know there are some who disagree with me, and perhaps this is one way our society will ultimately deal with its flood of elders in this age of limits. I will by then, I hope, be old and no longer on the front lines. When my time comes -- before it comes -- I will choose for myself. But for now, as long as I have the will and the strength to practice, I am a physician firmly rooted in the art and tradition of healing, of comforting.

So instead, I will tell my brother that I will handle it and hang up the phone. Then I'll pick it up again and dial 911.

Author's e-mail: jwinakur@aol.com

Jerald Winakur, a Maryland native, has practiced internal medicine and geriatrics in San Antonio for almost 30 years. He is an associate faculty member at the Center for Medical Humanities and Ethics at the University of Texas Health Science Center. This essay is adapted from a longer version in the July-August issue of Health Affairs, available online athttp://healthaffairs.org.