KILLING MAMA

Delores, a matriarch, raised five children after Walt died in an accident.  The litigation resulted in an award that made them comfortable for the rest of their lives.

The grown children were employed and living in the same county, save for Katherine, the eldest, who was not employed but living across the street.  She'd attended Bryn Mawr College, degreed in journalism, and had adopted extreme feminist views.  She married in her mid-30s, divorcing three years later without children, never to remarry.

Known as "KiKi" to her family and friends, Katherine was close to her mother as a child.  But their relationship became estranged in adulthood as the two women each had controlling personalities.

Three of KiKi's four brothers were divorced with partners and all had jobs.  The brothers always acquiesced to KiKi's penchant for planning family events.  KiKi liked to have things done just right.

Now in her 70s, Delores had become feeble and forgetful, but was very much engaged in her home life.  She enjoyed television, especially Family Feud.  In the event she was ever unable to care for herself the children agreed that Mama was never going to be placed in a nursing home.

KiKi looked in on Mama, taking care of her needs, but their estrangement resulted in frequent arguments and displays of arrogance by KiKi.  Mama's passive aggression irked KiKi who was unsuccessful many days in getting her to bathe and eat.  Mama was more cooperative when the boys were there.  She eventually became deconditioned.

She was admitted to the hospital with a urine infection and sepsis, then two weeks later readmitted with pneumonia.  A month later she fell, injuring her back, and was hospitalized.  She was recovering well when she had another bout of pneumonia requiring another hospitalization.

The doctor recommended to KiKi and the boys that Delores needed 24-hour care and needed to be placed in a nursing home.  Their response was "We're not putting Mama in a nursing home!  And that's that!  We talked about it and we are going to take care of Mama at home."  The doctor reminded them that it would be stressful and a strain.  KiKi said, "Mama has enough resources to last her till she's a hundred and we're going to work in shifts."  So the doctor recommended Home Healthcare in
hopes of preventing the recurrent hospital stays.

KiKi was there during most weekdays and they all rotated taking one weekend a month with the boys taking one weekday.

But the recurrent admissions continued.

The hospital administration, aware of the financial penalties levied by Medicare for untimely recurrent admissions, directed the social worker to advise the doctor to consider placing Mama on hospice.  Their quiet hope was that this would avoid recurrent hospitalizations.

The doctor, a salaried employee of the hospital and wanting to curry favor  with the administration, signed Mama up for hospice even though she had no terminal illness that would cause her to die within the next six months, the loose Medicare qualifier for admission to a hospice program.

KiKi and the boys had become stressed, tired, and burned out over being inconvenienced, often arguing over the work schedule and its interference in their lives.  So when hospice was explained to them, having resolved to keep Mama out of the nursing home, they realized in a bittersweet moment that this might be a remedy to their situation.  The doctor easily persuaded the family to accept hospice care emphasizing that though she had no terminal illness the 74 year-old had a history of recurrent problems.  Also, the hospital-salaried doctor, desirous of currying favor with the administration, shared his opinion that Delores was not going to live very long anyway -- even though he would have been hard pressed, if asked, to cite clinical or scientific evidence that this was the  case.

Since KiKi was the point person, the hospice nurse instructed her in giving morphine, though Mama was not in pain, telling KiKi that in case her mother had pain in a few days that she would have it available to give.  KiKi was to give 3 mg morphine every eight to twelve hours if her mother complained of pain.  KiKi considered this carefully.

Mama and KiKi continued their controlling dance with each other.  Mama often refusing to take a bath or eat a meal, making it difficult for KiKi who verbally lashed out.

One day, after an argument, KiKi gave morphine after which Mama slept for six hours.  KiKi, aware of the free time, ran home to catch up on housework and chores.

On the following day, in spite of hearing no further complaints from Mama, KiKi increased the morphine to 6 mg telling Mama that she understood and that if she was feeling really bad to just "let it go"; that she could be with Daddy.  She upped the morphine schedule to every four hours.

The hospice nurse checked the morphine dosing schedule but made no corrections.  KiKi continued to administer the 6 mg dose, the cumulative sedative effect causing her mother to sleep even longer, and with a slowing respiratory rate. 

The boys noticed she was more subdued than usual and they'd never heard Mama complain of pain.

Soon the morphine slowed Mama's shallow breathing to ten breaths per minute.  The nurse told KiKi "it won't be long now."  And it wasn't.

Per their wishes Mama never spent a day in a nursing home and died peacefully at home.  Her children returned to their former lives.  The hospice agency pocketed a higher profit because Mama died sooner rather than later allowing them to retain the lion's share of the $24,527 Medicare monthly capitation payments.  And the hospital had rid itself of a "repeat offender" who had caused unwanted financial burdens and write-offs.

It was all clean, neat, and final.

As for death panels?  Who needs them?  For some, they're already baked in the cake.