Right now, what Minga wants most — to go home and to find a way to get dialysis there — seems to be in conflict with what at least some of her nine adult offspring want for her. They want her life to be preserved for as long as possible, and believe the best way to do that is for her to remain in the city and receive dialysis at the ambulatory center.
I’ve done a lot of research, and feel reassured that manual peritoneal dialysis at home is viable among the options open to her. Apparently she is likely to feel better getting peritoneal dialysis every night while she sleeps, instead of hemodialysis three times a week. Daily dialysis more closely mimics having actually functioning kidneys. The biggest risk is infection at the new catheter site in her abdomen, but she’s not free of infection risk now, with a catheter in her jugular vein for hemodialysis. No one in her family in the village, at least at this point, feels able to be trained to help her hook and unhook the manual system. I’m prepared to pay Gloria to do that — which crosses a big cultural line. For the family, my hiring Gloria would signal to others in the village that Minga’s family doesn’t care enough about her to help.
I understand all of that. What the nine adult offspring think about their mother’s care certainly matters. So does the cultural expectation that care will come from inside the family. But something matters more: Minga’s own choice about what happens to her life.
Many months ago I read a compelling piece in the New York Times about a woman suffering from Alzheimer’s who lived in a state that allows physician-assisted suicide. The woman was clear that she wanted to take that option while her mind was still clear enough to set the process in motion. When that moment came, her adult daughter begged her to reconsider: things weren’t that bad yet, the daughter and a small grandchild needed more time… Painfully, and with deep regret at adding to her daughter’s pain, the women went forward with her decision, and died on her own timetable.
I think Minga’s family is experiencing something like that here. I suspect Minga understands quite well that back in the village, something might happen with the dialysis process that would shorten her life. I’ll be able to confirm that when I’m there in a couple of weeks. I suspect that her adult kids are not yet ready to let her go, and feel sincerely that her staying in the city offers the best chance of longer survival. There’s no way to bridge the difference here. One or the other viewpoint has to prevail.
I think it’s Minga’s call, and I’m prepared to stand with her as she makes it.