Sacred Trust

“I understand. Have you had an aide helping you with your mother at home?”

“No. I didn’t want my mother thinking I’d abandoned her to a stranger.”

“So you’ve been taking care of her yourself?”

“My daughter helps when she can.”

“I’m sure that’s very hard on you, Mrs. Richmond.”

“Call me Ivy. Is she still moaning?”

“She was peaceful when I left her a few minutes ago. We gave her an injection. We ran some tests to see if there might be a pneumonia or something else causing her deterioration.” He paused. “I’m sorry, Ivy, but none of the tests show a secondary problem. I’m afraid the cancer is taking her.”

Ivy nodded slowly. “Hard to believe a little mole on her cheek could do such damage. Melanoma, you know.”

“Yes. I’m sorry. Her oncologist is in Springfield?”

“Yes, but it’s no use calling him. He’ll just increase the morphine.” Fatigue sharpened her voice. “She’s not worth his time. She’s just an old woman.”

“We want to make her as comfortable as possible. I understand you have the DNR request she signed?”

Ivy grew still as her eyes flashed back to his face. Her chin lifted a fraction. “Why?”

“Would you like to sit down?”

“I’ll stand.”

“I know you must be tired. I want to honor your mother’s advance directive, and to do so, I need the DNR sheet. This is all just legalities, and I apologize for having to ask you for it at a time like this.”

“You mean to just let her die?”

Lukas flinched at the harsh tone of her voice and the sudden, angry-suspicious expression in her eyes.

“If her heart should stop,” he said gently, “we wish to honor her request not to restart it.”

“What’s this ‘we’ business? You’re the doctor. You call the shots. I don’t want my mother’s heart to stop, and if it does, I want you to start it again.”

He held her suddenly angry gaze for a moment. She couldn’t know what she was saying.

“Mrs. Richmond, I thought you understood about your mother’s request.”

“My mother is not capable of making that decision now. I have power of attorney, and I don’t want you to just let her die like some worthless old woman. She’s a living human being with a soul.”

“Of course she is.” He hadn’t foreseen this. How could he get through to her? “I’m not talking about euthanasia. I’m talking about allowing nature to take its course, allowing your mother to retain her dignity and keep her from unnecessary pain. I’ve asked a nurse to call your daughter, Dr. Richmond, and she should be here—”

“You did what?” Her dark eyes flashed, and fatigue tightened the tension in her voice.

Lukas blinked at her helplessly. This was not going well. She was clearly, and understandably, irrational from lack of sleep. There had to be some way to make her see, without becoming too graphic.

“I specifically delayed calling my daughter because I wanted to put her through as little heartache as possible,” Ivy said. “She’s been through enough. You had no right to call her.”

“I’m sorry you feel that way, but Mrs. Conn’s condition is getting worse. I felt family needed to be here.”

“Not yet!” She paused with a gasp, placing a hand on her chest.

He stepped toward her. “Are you okay?”

“I’m fine.” Lowering her hand, she took a deep breath and held his gaze. “I don’t care what the DNR form says. I have durable power of attorney, and I want you to do everything for my mother. She’s not ready to die. She’s not…”

“I didn’t mean for this to be so difficult.” Lukas kept his voice gentle, resisting the urge to ask if he could examine her. He’d seen this kind of family reaction before, during his oncology rotation, when a caregiver was so exhausted that they became confused and combative. They often blamed the physician for the pain of their dying loved one. “I will contact Mrs. Conn’s family physician and clarify the matter.” He turned to leave.

“You don’t believe I have power of attorney?” she challenged, her voice rising a decibel.

He paused with his hand on the door. Lord, give me compassion.

But what about Mrs. Conn? She would suffer even more pain if they managed to resuscitate her.

He turned back to face Ivy, and he tried to keep his voice gentle. He knew his words were not. “What I believe is immaterial, Mrs. Richmond. For instance, I believe that to impose heroic measures onto a patient suffering the last stages of advanced carcinomatosis is not only transferring much-needed care from the living to the dying, it is inhumane to the dying.”

“Only if you don’t believe in hell.”

“Mrs. Richmond—”

“Ivy! My name’s Ivy!”

“I’m sorry, Ivy. I do believe in hell. I also believe that your mother is at peace about this. She told me she was ready to go.”

“What do you mean, she told you?” Ivy snapped. “Mother hasn’t spoken in days. What are you trying to pull here?”

Be gentle. Be patient. But what about Mrs. Conn? “Ivy, to try to resuscitate your mother at this stage would only cause greater, unnecessary suffering. And for what? A few more minutes or hours for the family to say goodbye? What about your mother’s feelings? She’s made her decision already.”

There. He’d done it again, him and his bad habit of stating his opinion to the wrong people at the wrong time. But if there was the slightest chance Ivy would listen…

She bent her head, her eyes closed for a moment. He watched her hopefully.

She reached into the right back pocket of her jeans and drew out a folded three-page form. “I had hoped it would never come to this.” The strength had left her voice. She unfolded the papers and held them out with shaking hands. “I have the power of attorney. Are you satisfied?”

Beverly caught up with Lukas as he reentered the E.R. proper. “That Mustang’s mine!”

Lukas struggled to work up some enthusiasm. “Don’t tell me you cajoled Dr. Wong—”

“Nope.” She jingled Cowboy’s keys. “Sweet-talked one of the new EMTs to help me. Buck likes animals.”

“Yes, but did you tell him this wasn’t a gerbil?”

She grimaced. “He knows it’s a big animal.”

“Horses are big animals. How will you feel if your helper comes back in here on a stretcher?”