The aging hearts of our loved ones are multifaceted for sure. Kind, funny, witty, intelligent, brave, accomplished, and if we’re lucky, loving with a lifetime of experiences all wrapped up into a well-lived life. Certainly a life deserving of respect, all the best medical care, compassion, understanding, and help to navigate this final stretch of the journey.
My mother was fiercely private concerning her medical care. She did not want anyone, other than my father, to know what doctors she was seeing and why. When it became obvious to my (physician) husband and I that her condition was deteriorating, stepping in became a delicate balancing act.
My final journey with my mother began over two years ago when I noticed she was exhausted much of the time and her breathing was labored. My husband spoke to me about his concern in private, knowing to tread lightly. Whenever either of us asked her how she was doing, and expressed concern, she very firmly stated that nothing was wrong.
When she began having difficulty with memory and recall, she reluctantly agreed to see a neurologist friend of ours. After testing, he concluded she was experiencing normal progression in aging. Her energy level, however, continued to decline. She assured us that she was fine and was seeing a cardiologist for chronic A-fib, which my father confirmed.
A few months later she ended up in the local emergency room, the result of a fall. Although her cardiologist had an office in the same hospital, we discovered that his records were not linked to the hospital system. Consequently, the ER doctor, not having the cardiologist’s records on my mother, took her off blood thinners because she felt the risk of injury from fall was greater than the benefit of my mother remaining on her medication. This likely contributed to the further significant decline of my mother’s condition. When my husband discovered her medication had been stopped he had my father call their cardiologist immediately to correct. We encouraged my father from that point on to keep a physical copy of their medical records with him for every future trip to the hospital and doctor’s office. Unfortunately, not every patient has the luxury of having a physician in the family.
Sadly the other effect (we assumed of the fall) was significant cognitive impairment. When re-examined by her neurologist, she had declined drastically. He secured and poured through all of her medical records. He found she had been diagnosed with mitral stenosis and severe pulmonary hypertension years before which were contributing to her confusion.
Together, my father and I decided that I would be included in Mother’s next cardiologist appointment. Given her condition I stated at that visit that we would like her to see an Interventional Cardiologist. I’ll admit I was a bit skeptical before meeting this new doctor, as all we were offered to this point was monitoring. When Dr. Ankur Kalra walked in, he was extremely welcoming, respectful, and had actually taken the time to read Mother’s entire chart before meeting with us—this was a first! He was very kind and honest from the start. He told us she actually had Rheumatic Mitral Stenosis and that he could offer a procedure called valvoplasty. This procedure could potentially give my mother great quality of life for her remaining years.
As a teacher, I appreciated his unique ability to explain this complex diagnosis and procedure in terms my parents and I could understand. And, he took as much time as we needed to feel comfortable with the next step. Dr. Kalra had given us so many gifts that first day. His world-renowned expertise, his genuine kindness and caring gave us hope for the first time in years. He also gave us his cell phone number in case we had any questions or concerns.
Although blood clots ultimately prevented my mother from receiving this procedure, Dr. Kalra’s care did not end there. He took time out of his busy schedule to meet with our family and discuss how best to care for Mother. He set into action Home Healthcare, having a nurse perform home visits and enabling him to monitor her INR. He even discussed (in person, by phone, or by text) when to get Hospice involved, end-of-life decisions, and what my father could expect every step of the way.
Everything Dr. Kalra did enabled my mother to have the best quality of life possible, to live out her final days as she wanted to. My mother was a woman of deep faith. She was not afraid of dying. Quite the opposite, she knew Heaven was her ultimate destination. It was her wish to remain in her home, and she did. She was able to live out her final days in the home she loved, with the people she loved, and in her words, “with the best husband I ever could have asked for” for all but her final six hours.
When Dr. Kalra learned of my mother’s passing, he asked to meet with my father and myself. When we met we were yet again amazed. His mission was to share a cappuccino and make sure we were doing all right. Talk about a lesson in compassion… I feel it is worth mentioning that although Dr. Kalra was the newest cardiologist on my mother’s case, he was the only doctor (who was not a family friend at the time) to follow us through her death.
Lessons learned on the journey:
1. The best way to preserve a loved one’s dignity is to be their advocate.
2. Always be respectful but get involved as needed. Get referrals, go to appointments, ask the difficult questions so your loved one has all the information necessary to make their decision.
3. I always knew and respected the fact that the final medical care decision would be my mother’s and father’s to make. Even if the decision was no further procedure.
4. My role was to connect my loved ones to the best possible medical specialists.
5. There simply are no words to adequately thank someone for giving you more quality time with your loved one. I am eternally grateful to Dr. Kalra and the other doctors on my journey who truly care for their patients and families.