"Your aunt has lower gastrointestinal bleeding. Do you want us to send her to the hospital?"
The call from the nursing home came shortly after supper. My 97-year-old aunt's chart identified me as having power of attorney over her affairs. I had also signed the advance directive, a form that indicates different levels of care, such as under what conditions a person should be sent to the hospital or remain in a nursing home.
The staff needed to confirm that my request not to send her to hospital was still in effect. As her power of attorney, the final decision was mine.
"I'll call you right back," I said. No way could I decide without first thinking about it.
There was no doubt in my mind that my aunt needed serious medical attention and should be in a hospital. Yet, I was hesitant. The previous year, during a hospital stay after she had fainted, the only care she received was an IV and bed rest for a week. That was it. During that time, she managed to rip out her IV, fell out of bed, bruised her arm and returned to the nursing home in worse shape than when she went into the hospital. But this time, they might be able to help her. Should I send her or not?
Having power of attorney is not a glory job. It is a responsibility. In 1999, when at the age of 90 my aunt first asked me to be her power of attorney, transferring this responsibility from her aging brother to me, I felt honoured that she thought so highly of me. I gave no thought to her future needs.
A delightful woman, she had never married. Her extended family loved her and she was one of my favourite people. She lived in her own apartment and was healthy and full of life, taking the bus to her bridge club and daily walks to the market for groceries.
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Accepting her request was easy. I took pleasure informing relatives of her decision. Secretly I felt that she loved me best. Would I have done so if I had known about the turn her life would take? Suddenly I had to deal with moves from her apartment into a retirement home and eventually, a nursing home. I was responsible for getting her to all her doctors' appointments, dealing with her financial situation, paying her bills, doing her taxes and cancelling subscriptions and services. Any problems, either existing or foreseen by the family, were left to me to solve. I had responsibility for every aspect of her life.
At the beginning, sharing her new adventures was fun for both of us. Unfortunately, macular degeneration, cataract and cornea problems led to the complete loss of her eyesight and ability to enjoy her passions - playing bridge and reading. Her hearing was already diminished. In 2005, I had no option but to move her into a nursing home.
Living in a healthy body with a mind that had lost interest in the world around her left her with no quality of life whatsoever. Dementia appeared full force.
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During my weekly visit she would say, "If you are a religious person could you please pray that I die." It became a familiar refrain as she repeated her request over and over, making her wish no secret to the nursing home staff and everyone who visited.
It was now up to me to make a decision. Would a hospital stay change her condition? What would the people at the long-term care facility think of me if I refused to have her sent to the hospital? If I didn't get her the best care possible would family members accuse me of reneging on my responsibility and accuse me of speeding up her death? Would I be able to live with my decision? Was I writing her death sentence?
After debating the issue with my husband, we decided to send her to the hospital. But during the few steps it took to go from the living room to the telephone in the kitchen to call the nursing home, I heard in my heart my aunt's pleading: "Pray for me to die." I knew if the decision were hers to make she would refuse to go to the hospital. I called the nursing home and told staff not to send her.
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The following day, as her family gathered around her bed, staff came often to check on her and give us support. Within 24 hours of their call, on April 13, 2007, my beloved aunt died painlessly, quietly and with dignity.
It pleased me that instead of being in a hospital she died in familiar surroundings with caring staff who knew her habits and how to make her as comfortable as possible.
I still feel honoured that she chose me for the duties of power of attorney. I hate to admit that at times I resented this responsibility. Yet knowing what I know now, I would do it over again. Being her power of attorney was a privilege. But if I am ever asked to take on those duties for someone else, knowing the stress and responsibility it entails, I will think twice.
I know my aunt was grateful I followed her wishes, and I don't feel guilty that I didn't send her to the hospital. I take comfort in the knowledge that by keeping my aunt in a place where she felt most secure, I granted, with respect and love, her wish to die.
It was my last act as her power of attorney.
Louise Szabo lives in Nepean, Ont.