Cruelty or Evil, Which is Better?

When my mom broke her hip this past Tuesday, the four of us siblings had to decide whether or not she would have surgery to repair the break. Because mom has late stage dementia, she could not make the decision herself. Deciding whether or not mom should have surgery felt like deciding to be cruel or to be evil.

At first the doctor said that the surgery would involve a small incision and securing the break with three screws. Later, he said that the entire ball at the end of femur should be replaced. Do we subject mom to such an extensive surgery? If we did, she would not understand the pain, nor would she be cooperative through the physical therapy needed afterwards.

About a year ago, we had made a decision with mom's team at the Good Shepherd home, the dementia unit where she lived, that the only goal of any medical treatment mom received would be her comfort. Mom was not to have any but the most basic medical treatment.

Then she fell. At first we thought that there would be no treatment other than pain killers. But the people at Good Shepherd wanted an x-ray to determine whether mom was still eligible to live there, or whether she needed nursing home care. If her pain was merely a bruise, then she could stay, but if it was a break, she would need to move to the nursing home section of their campus. We understood and affirmed their reasoning and approved the x-ray.

The mobile x-ray done in her room was inconclusive; mom would need an x-ray at the hospital. The hospital x-ray showed a break between the ball and the shank of her femur. Due to the location of the break, they told us that mom would neither stand nor sit again if we did nothing. When anyone must spend their life lying down, risk of pneumonia skyrockets. In fact, one of mom's doctors at the hospital told us that in the 30 or so years of his practice, he had five patients like mom who were old and could no longer stand nor sit due to a broken hip. The doctor said that all five died within two weeks of getting the break. When we discussed mom's case with the surgeon, he told us that mom's pain level would subside considerably if they replaced the ball of the femur with a prosthesis in surgery. She would be able to sit up and maybe even walk again.

To subject her to surgery would risk the complications as well as putting her through the pain involved with the surgery. To decide not to have surgery would be subject her to even greater pain and expect that she would pass away within a few weeks. It felt like a decision between cruel and evil.

We decided that she would have the surgery. Not to do so would have been a death sentence with severe pain right up to the end. Considering mom's age, 90, she made it through the surgery well. She is in relatively good physical condition because one of the main ways she spent her days before faling was pacing the halls of the Good Shepherd home.

Because she doesn't remember that she had surgery, nor remember that her hip hurts, she keeps moving her injured leg then cries out in pain. She receives pain pills which help some. We have to assure ourselves that her pain is less severe than it would have been if she had not had surgery. We also can reassure mom that her pain will decrease day by day, something we could not say truthfully if she had not had the surgery.

Deciding between the lesser of two evils is never easy. It helps that mom receives very good care, and that us four siblings so far have been able to agree on what constitutes the greatest level of comfort for mom. So we made our decision, and mom has to live with it. We made the right decision, but seeing mom in pain after surgery still feels like we opted for cruelty.