Care Planning, While Hard, Helps Filipino Families Honor Dying Patient

Care Planning, While Hard, Helps Filipino Families Honor Dying Patient

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: Aurora Cudal, left, and her family made the tough decision to respect her husband Winlove’s wishes to die naturally—and not prolong his life artificially.

Part 2. Read Part 1 here. 

LOS ANGELES –San Jose Mercury News journalist Lisa M. Krieger faced an unthinkable ordeal in June 2011, as she rushed her 88-year-old father to Stanford Hospital, due to a mysterious infection.

In her award-winning series entitled, The Cost of Dying (published in Mercury News), Krieger recounted the upheavals, questions and lessons that she learned from this whole experience.

This past May, Filipino Press columnist and health care educator Aurora Cudal faced a similar dilemma, when her husband suffered a massive stroke (his third), which forced her to choose between prolonging his life or following his advanced directive.

Like so many others in the United States today, Cudal and Krieger had to make difficult decisions — choosing between life and death.

Their experiences also demonstrated the importance of palliative care and advanced directives in the most trying moments of their lives.

The Cost of Dying

Ken Krieger (who developed an advanced form of dementia late in life) was hospitalized for 10 days and was given several diagnoses, including an aggressive form of blood infection, weak breathing, high white blood cell count and skin infection.

For the first five days, doctors performed aggressive treatments aimed at prolonging his life—even as they told Lisa it would be “a long and bumpy recovery, with no guarantee of success.”

After five days of futile efforts to cure Ken – at hospital expenses averaging $56,750 per day -- Ken was put in a private room and placed on hospice care, and administered with painkillers. The cost: $10,000 per day for four days – and $100 on the 10th day, when he died.

The total cost of his hospitalization was $323,658.

If Lisa’s frugal father had known that his hospitalization cost them that much money (only $67,809 was shouldered by Medicare), he would’ve been infuriated. Ken was explicit about his medical directives: That he be allowed to “die a natural death.”

According to Lisa, Ken’s directives were pre-planned to avoid protracted suffering and “costly heroics” to prolong his life. Overwhelmed by the information and multiple suggestions from the doctors for aggressive treatments, and out of her desire to prolong Ken’s life, his daughter – a respected health and science journalist -- unwittingly set aside her father’s directives.

“Just because it’s possible to prolong a life, should we,” Lisa asked?

Lisa’s experience brought forward another question that begs to be answered: How do we choose between the desire to prolong a loved one’s life and the option to respect the wishes of our ailing loved ones?

Is there even a choice at all?

Respecting Advance Directives

Filipino-American columnist Aurora Cudal, 80, had to make a painful decision: let her husband live longer or respect his directive.

Prior to his third and ill-fated stroke in 2013, Winlove Cudal had already suffered two strokes, which prompted him to lay out the terms of his advanced directives to his wife.

According to Aurora, having that conversation with her husband was a “very, very difficult time” for her. Nevertheless, the couple put the advance directive in order.

When the third cerebrovascular incident happened, the attending neurologists and physicians all said that the stroke was massive: 60 percent of Winlove’s brain had been affected, making him fall into a coma. Although aggressive treatments would have prolonged Winlove’s life, his directive was clear.

“He just [wanted] to die peacefully with dignity,” Aurora recalled, “He just wanted to go without any intubation,” that is, insertion of a tube to add or remove liquids.

Aurora said following her husband’s directives was very difficult. She believed that if the doctors had provided more curative medicine, they could have prolonged Winlove’s life. However, the doctors explained that pursuing further treatments would just delay the inevitable.

Decision Making

Aurora looked back on the experience of a friend who had faced a similar situation. Her friend decided against the directives of her husband and instructed the doctors to pursue aggressive treatment. But even with all the doctors’ efforts to prolong his life, her husband still didn’t make it.

When her husband’s case came up, Aurora rounded up her family members to discuss the next step. Aurora talked about the pros and cons of each scenario.

Inevitably it led to this question: “Do you want your Dad to suffer, to live longer, or do you want to honor his memory and to honor his decision by letting him go peacefully?”
She recalled, “We were all crying when we made the decision.”

As painful as it was to “pull the plug,” the Cudals ultimately chose to adhere to the advanced directives of Winlove.

Winlove’s Remaining Days

For his remaining days, Winlove stayed at a hospice facility. After being administered a morphine drip for five days to suppress his pain, he breathed his last on June 2, 2013, surrounded by loved ones. Aurora said that she even had to explain to their grandchildren why their grandfather had to undergo the process.

According to Aurora, palliative care and hospice greatly helped in making the ordeal bearable for them. Aside from pain management for the patient, the programs also provided spiritual and psychological support for the patient and the family.

She said that loved ones involved in a case like this are often emotionally compromised and really “cannot think right.”

But with the support of the hospice, the Cudals were given objective guidance throughout the whole process.

“I think it helped us a lot,” Aurora said. In the end, Winlove’s directives were what mattered to Aurora and her family.

Mico Letargo wrote this article for Asian Journal through a California Healthcare Foundation Journalism Fellowship, a project of New America Media in collaboration with the Stanford In-reach for Successful Aging through Education Program.