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Over the Back Fence By HANK HENRY Scenario became a reality W hen I wrote last week's column about advance directives and end-of-life decisions, I had no idea that I would soon be involved in one of those difficult decisions myself. No sooner had I finished that column than my brother's longtime companion called to say his health had deteriorated. Suddenly I was confronted with the same situation I had written about. Some of you may remember that back in February, I wrote about my brother, Lee, and his health problems. Doctors had discovered Lee had both Parkinson's and Alzheimer's diseases. Just after I finished last week's column about advance directives (the forms that tell doctors how to treat you if you cannot speak for yourself) Lee's longtime companion called to say that he had not been out bed for almost two weeks. He also was losing his ability to swallow (a situation which is not unusual in some Parkinson's cases). Lee had no sign of the trembling hands commonly seen in Parkinson's patients (but from what I have read, about 30 percent of all those cases have dementia without necessarily having the palsy). The first little signs of his condition surfaced about seven years ago. He had good days and bad days, but eventually the bad days began to outnumber the good. I used to call Lee every Saturday morning and we would talk about his life in the up-scale "retirement hotel" where he lived. Our conversations in the first few years covered a variety of subjects, but that all changed in the past few months. His conversations no longer made sense. Once he told me he couldn't talk for long because he had to meet his brother at the airport. I was the only brother he had. Lee was moved from his retirement home to a veterans' hospital, where he was immediately placed in an intensive-care unit. Two days later, a doctor called and said Lee was being transferred to a nursing home down the street from the hospital. Then a doctor from the nursing home called and said he wanted permission to install a feeding tube directly into Lee's stomach. I told the doctor I would call him right back, and then I called Lee's friend. As next of kin, I would have to make the decision, but I wanted her input. She had told me earlier that Lee had never signed an advance directive. We were both torn between the alternatives: should the doctor install the feeding tube and prolong Lee's life -- or not install it and possibly hasten his death? We finally agreed that given his irreversible mental deterioration, the humane thing to do was not to install the tube. I called the doctor and told him of our decision. He said they would make Lee comfortable and offer him food. The next day, Lee's companion visited him in the nursing home. He was sitting in a wheelchair, and was actually eating a little bit. Some volunteers were there, playing and singing songs for the patients, and Lee's companion was startled when he sang all the words to "Old Man River." But there was no indication that he knew her. (It's not uncommon for a patient who can't talk to be able to sing.) Lee hung on to life for several days. Then, at about four o'clock one morning, a doctor called to say that my brother had died within the hour. Lee's companion told me that he had long ago purchased a pre-paid cremation and had arranged to have his ashes scattered at sea. There was no service. A couple of friends in the medical profession here told me that our decision to reject the feeding tube was really the only course that made sense in view of Lee's mental condition. But for a time I felt almost like a murderer. Please get and fill out an advance directives form. Don't leave it up to relatives -- or even strangers -- to make those difficult decisions for you. (Hank Henry is a retired Jackson County commissioner and a former radio and television announcer. Call him at 772-9055.) Prime Times front page Mail Tribune front page Copyright � The Mail Tribune 1999, Medford, Oregon USA