My Aunt is 95, in stable health, with some dementia and memory loss. She requires a companion (private pay) because of advanced macular degeneration and memory problems. She is also in an assisted living facility so she has checks at night and medication management.
She has had her pacemaker ten years and it needs a new battery. The cardiac unit at the hospital called me and asked me to consider not changing the battery.
They told me to talk with her doctor and the other family members to decide.
She is not pacemaker dependent, but I was told her pacemaker helps correct the electrical signal to the heart one or two times per 100 beats. They expect falls and possibly injuries from no pacemaker.
Basically, they provided a life sustaining treatment that they now want me to consider removing it. How does anyone make this decision? I love my Aunt. I enjoy my Aunt. She is loving, caring and cracks jokes constantly. Her caregivers are loyal and loving and go to work to have fun! They laugh all day and love on my aunt as if she were theirs. She visits with other residents where she lives and participates in music and scenic drives. She also has pain from a hip replacement that has gone bad, and is in a wheelchair except in her room. She is frustrated because she can't remember why she can't see. She has expressed not wanting to live, then almost instantly shifts to humor and wants to go do something. She confided to me five years ago that she wasn't sure she made the right decision to get the pacemaker. But she was independent and living at home at the time and I remember she didn't give it a second thought. I am guardian, health care power of atty and durable power of atty. I have been closely involved with her for the last six years taking care of every aspect of her care and financial matters. There is plenty of money, but it's disappearing fast. I feel that my decision will cause her pain either way I go. Prolong a life with immediate, present small joys and pain, or authorize the possibility of injury and death which goes against every fiber of my being. Does anyone have any wisdom, experience or advice? Thank you.
The doctor suggested that Hubby and I discuss this and come back in a few weeks. I said we'd been discussing it for more than a month, and only when Hubby was in a lucid period. This is what he wanted.
Well, the doctor did not agree to put him through surgery just to remove the device, but the battery needed to be changed in a few months anyway and he would do it then, if Hubby had not changed his mind.
Apparently the cardiologist gave this a lot more thought over the next months. because when it was time for the battery change and the defibrillator was removed, he came into the waiting room to tell me all went well and that "you've made the right decision."
In my husband's mind, and I guess mine too, the pacemaker was a quality-of-life device. Keeping the heart at a regular pace had every day benefits. The defibrillator was an extend-the-life device. Hence one was OK in the circumstances, and the other was against his DNR.
What are the risks from having the relatively routine battery-change surgery? What are the risks if the battery really is dead? Once you have this as clear in your mind as you can, share it with your aunt. You'll have to judge how well she understands your explanation and how much weight to give her answer, but I think if possible she should have input on this question.
I will distill this the best I can and I will talk to my aunt. She can track a little bit on some days, and I think she will understand. She will immediately forget the conversation, but I have had success going over it again at another time and again at another time and if she ends up with the same answer, I can be pretty sure it's what she wants. I know her well enough to know how she thinks and I agree she needs a chance to try to understand and decide for herself.
At the facility where my aunt lives, this issue arises and the pacemaker is considered a life sustaining treatment and therefore in violation of the DNR. My aunt made her DNR after the pacemaker was installed. But about that time, she expressed her reservations about having gotten it. How she feels about it now I don't know. I know how I feel about it. But if she clearly understands the implications and wants it to stop, I will do what she wants. I too, would be very concerned about a dead battery left in her chest. The clinic said they would do nothing to remove it.
I am reminded again how valuable this site has been and all you wonderful people who give and sacrifice and face the most difficult situations of life and death and then take time to share and help. Bless you all.