A conversation with an Oncologist recently brought me back to a client I shared with this Doctor.  In her mid-50’s and with so many hardships, it was very difficult to believe that now she would be suffering the effects of Brain Cancer.   Twila was a small woman in stature with the look of a person who had led a very difficult life.  She became my client after a recent diagnosis of Brain Cancer without option of surgical intervention.  I sat with both the Oncologist and Twila as she received this news.  She was well educated and at this point a good advocate for herself.  She asked about options for Chemotherapy and Radiation.  Chemotherapy was out of the question because Twila was a long-term Alcoholic.  Leaving only radiation as a possibility and we (the three of us) discussed the long-term goal for Twila. 

Having met Twila only recently, I knew little about her background and even less about the safety network of friends and relatives.  Twice in our conversation she had started to ask a question and then backed away from it.  When our interview finished and it was time for Twila and I to make plans for her future, I quickly ask what the question was she had tried to ask in our meeting (truly I knew what she wanted but needed her to voice it).  She was concerned about moving into a skilled nursing facility and not having her whiskey.  I immediately called the Oncologist, who as it turned out was at the nursing station writing discharge orders for her.  He came back in and we discussed the request for whiskey.  He was willing to write an order for her to have one ounce of whiskey each evening; which I knew would be titrated up as her condition worsened.  After that I told Twila I would meet her at the nursing home in two hours, for us to put together a plan to her liking.

Twila’s request was not unusual in today’s medical field.  Gone are the days when if a person was a chronic alcoholic admitted to the hospital for long-term or to a nursing home, they were not allowed to have any alcohol.  One part of medicine today which has come so far is the debate of quality vs. quantity.  Today, it is more important to use the medical field to augment the person lifestyle in as many ways as possible, especially when the person is terminal.

Over the next few days Twila and I met several times (as when she became tired, I would tell her I would be back at a specific time).  She was doing the work of a lifetime in what was less than 30 days to live.  Twila’s husband was incarcerated and wanted to see her prior to her death.  We spoke of this twice on two different days; she did not want to see him.  Because their relationship was a tempests and neither one was ready to concede to the other.  I spoke with the warden and we agreed that should she want to see him up to the moment of death, if I gave him 3 hours’ notice – he would get her husband there.  I also spoke with her sisters (she had 2) and they were more salt of the earth kind of people.  By the time they arrived she was drinking 1 ounce in the morning and 1 ounce at night.  (The time of her drink had to be specific due to the medication she was taking.)  Fortunately the month was June and the weather was warm, so there was time to sit outside and do some catching up.  Privately Twila shared her most private wishes for last moments and her desire for what would happen with her remains.

Moving forward with the needs and knowing the outcome was not as difficult for Twila as one might think.  The last day she had no alcohol and no food; although she was still very clear minded.  She summoned her sisters and told them I was in possession of the “instructions for her last wishes”.   She ask for strawberries and whipped cream, which she ate with such gusto, I never would have dreamed that would be the end.  Twila’s passing was immensely peaceful and calm. 

I was called back to the nursing home due to the request of the sister of Twila.  Twila ask me to have a burial not a cremation, which seemed a waste of money to her sisters.  However, all was documented and there was little more than a discussion regarding this act.  Next they wanted all of her possessions which they did receive, however none of the joint property owned with her husband.  Twila had made arrangements through a lawyer to have this held in trust for her husband until his release.  And the last part of Twila’s story was she had asked me to have her buried with whatever remained in her last bottle of Whiskey.  Calling the mortuary staff aside when they arrived to pick up the remains, I ask them to sign for the Whiskey and gave them the written directive signed by Twila.

Looking at this case today, I am amazed at how much is taught by each client I have and how much is learned about the chemistry of a family.  We are now aware that people can have alcohol beverages while in a nursing home, it was not that many years ago that my uncle died from a blow to the head in a nursing home, because he could not have alcohol and he went into DT’s.  We now know the importance of documentation and finding the right lawyer, as individuals who are incarcerated in many states cannot own real property or any objects of value.  And we now can hold these thoughts close to our hearts to use if ever there is another need.