My Father and Sarah Palin

By BARRY FRIEDMAN

My father was dying, and I found myself thinking about Sarah Palin. nnDeath is funny (not funny) that way.

It was Sunday morning, Oct. 30.  I was eating a bagel when my father’s doctor, who also happens to be my doctor, called.

“I know I told you last week we weren’t at the end, and I think maybe I gave you hope — and I’m sorry — but things deteriorated pretty rapidly. I think we’re there now.”

“John,” I said — and, yes, I call my doctor by his first name —“you don’t have to be sorry. He’s 96.” 

There was no infection, no heart arrhythmia, nothing to really address. That was a problem. I was rooting for pneumonia, an infection, something you could battle, something you could cure.

But his dementia was now running the show.

And the show was about over.

He was aspirating.

When we eat and drink, the brain senses the food and/or liquid and instructs the three dozen or so muscles required to chew, swallow, and send such items down the esophagus and into the stomach. When the mind stops sending clear messages, though, the Oreos and the decaf with Half & Half, for instance, “go down the wrong way,” meaning it heads for the lungs or gets caught in the windpipe. When that happens in otherwise healthy people, we cough, we spit it out. But when one has dementia — and as the body weakens — the body not only doesn’t have the coordination and muscle acuity to start and complete the process of deglutition, it also doesn’t have the strength to expel the food that gets lodged in places it shouldn’t be.

When enough food stays stuck in the lungs or windpipe, the patient chokes to death, or comes down with something called aspiration pneumonitis, which is a cascade of inflammation as the body tries to expel interloping Oreos and Half & Half.

The only remedy is to stop feeding and hydrating the patient.

The patient then starves to death.

“We could do a feeding tube,” John said, “but I wouldn’t. It’s not my father, but I wouldn’t.”

There are three kinds of tubes: 

Nasogastric (NG) feeding tube, which goes through the nose, down the esophagus, and into the stomach.

Nasojejunal feeding tube (NJ), which, after going through the nose and down the esophagus, goes through the stomach and into the small intestine.

Gastrostomy tube (PEG), which is inserted directly into the stomach. 

On a 96-year-old man? Any of those? Please. 

And he still might aspirate.

“This is why the end of life in dementia can be so awful,” John said. 

I have a brother and a sister. We had to make a decision.

This, Sarah Palin, is what a death panel looks like.

It’s not a government board — it’s his three adult children who have less than a day to figure out how their father’s life should best end.

The conundrum is that, for decades, American medicine did not have the knowledge to intubate people and/or put them on respirators and/or give them drugs to keep their hearts in rhythm and/or prevent their blood pressure from spiking and/or dropping to dangerous levels. And now that we can, we do.

And of course we should.

I think.

A 96-year-old man with dementia and a feeding tube is kept alive only so he can be spoken of in the present tense. 

“The America I know and love,” Palin wrote in 2009, “is not one in which my parents or my baby with Down syndrome will have to stand in front of Obama’s ‘death panel’ so his bureaucrats can decide, based on a subjective judgment of their ‘level of productivity in society,’ whether they are worthy of health care. Such a system is downright evil.”

You know what’s evil? People like Palin who lie and sully other’s grief to score cheap political points.

The America I know and love engages in death panels every day, because the America I know still knows how to love.

According to Arcadia Healthcare, people who died in a hospital incurred a cost of $33,000; those who died at home incurred a cost of $4,700. Skilled nursing care is about $10,000 per month.

I would like to tell you that wasn’t a consideration, but it was. Tethered to an oxygen tank and being fed a mash of bananas, oats, and broth through a tube while sedated because he might otherwise pull out the tube is no way to live, even if the treatment is free.

To add bankruptcy on top of that — who benefits?

“I’m not going to a nursing home,” my father used to say.

But he said that years before he forgot he had a kitchen and a daughter and where to pee.

He wasn’t lucky enough to die in his sleep.

I was once on a courtesy bus with two men years back.

“Did you hear about Bob’s mom?” I heard one of them say. 

“No, what happened?” asked the other.

“She died.”

“Oh, sorry. How old was she?”

“95.”

“95? 95! That’s enough.”

My father spent six of the last eight days of his life in a hospital.

He died there. There was no feeding tube. It was enough.

His death panel lovingly made sure of that.

P.S. Sarah Palin got clobbered in her bid to represent Alaska in the House of Representatives a week to the day after my father died. I’d like to think there’s a connection.

Barry Friedman is an essayist, political columnist, petroleum geology reporter and comedian living in Tulsa, Okla. In addition to “Funny You Should Mention It,” “Road Comic,” “Four Days and a Year Later” and “The Joke Was On Me,” his first novel, “Jacob Fishman’s Marriages,” a book about the worst love story ever, was published by Balkan Press in February. See barrysfriedman.com and friedmanoftheplains.com.

From The Progressive Populist, December 15, 2022

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