Health and Human Flourishing: Religion, Medicine, and Moral Anthropology

8 A Meditation on Vulnerability and Power

c h a p t e r c h a p t e r 8 A Meditation on Vulnerability and Power Richard M. Zaner Hospitalized for more than four months, Mrs. Oland, who just turned seventy-two years old, has been married for many years to a gentle, caring man, Thomas Oland. Several years her senior and still in good health, Mr. Oland is looked to for making crucial decisions during those times when his wife is unable to do so. They have three adult children, two of whom live in other cities and the other in the same city as her parents. One daughter, Janice, and the son, Charlie, are regular visitors; the younger daughter (and youngest child) works and is unable to visit often; like her brother, she lives in another city; unlike him, she is able to get away from her job only infrequently. Mrs. Oland has been found to have frequent air leaks in her lungs (recurrent pneumothoraces), respiratory failure, prolonged hypotension, and end-stage renal disease (ESRD), any one of which could rapidly become life 142 richard m. za ner threatening. Her attending physician at this hospital (who has not treated her before) is Dr. Stanley Langston, who wrote in her medical chart that her prognosis is “dismal.” She is not expected to recover renal function or be weaned from the ventilator or the gastrointestinal (GI) tube—she is clearly terminally ill. Only sporadically alert, she is often unable to make decisions. A pulmonologist penned a note in her chart that “continued treatment is futile” and merely “prolongs dying,” and he recommended a Do-Not-Resuscitate (DNR) order. However, Mr. Oland insisted that they “do everything possible”; full supports are continued. A neurologist’s note states that Mr. Oland, Janice, and Charlie are “emotionally unprepared and confused,” and this prompts an ethics consult request. After a number of conversations, several themes behind Mr. Oland’s reluctance to accept the DNR eventually became clear: mainly profound guilt that he had regularly refused to listen to his wife when she tried to talk about her condition and that he would never be able to now. He had shushed her any time she tried to discuss what to do when her final days came; yet both knew this would happen. Since her hospitalization, he has been wracked with guilt and selfloathing : what neither had wanted—a terminally ill Mrs. Oland, bedridden and plugged into the vent and feeding tube, which only prolonged her dying—was now stark reality. In a way, this came about because no one at first seemed willing to discuss just what to do in the event of such a crisis. But their unhappy situation arose as well from flaws in communication with physicians and nurses—doubtless resulting in part from a kind of institutionalized impatience with details and a refusal or inability to address the unspoken. Still, resolution eventually occurred; she managed to die peacefully, with the family bearing up well. An Overview of the Encounter I was asked to consult by the attending physician. When I talked with him, he said right off that he had a “clue” for me: Mr. Oland’s strained reaction each time Dr. Langston brought up the need for a feeding tube. I learned, however, that the clue indicated something quite different from what he suspected. That difference became evident during conversations with Mr. Oland. It was not the existence of his wife’s feeding tube that upset him (or his A Meditation on Vulnerability and Power 143 children), but rather what he took to be its real significance. Several years prior, and just after she learned about how serious her condition was, he said almost in passing, that his wife had told him about a friend who had yanked out her feeding tube—she didn’t want “the damned thing,” did not want her death prolonged. The story jolted him, for he knew his wife had to be talking about herself, and he couldn’t bring himself to face that at the time. He became seriously locked into grief and guilt, which silently boiled beneath the surface. Because she couldn’t decide for herself, her doctors turned to him for a decision about limiting treatment (the DNR), and later about removal of all supports. He was stunned by the DNR and played dumb, telling them, and himself, that he couldn’t answer those questions. As...