My grandfather, who had been more like a father to me, was in a nursing home following a series of strokes and several years of decline. He had difficulty making himself understood, and other family members were beginning to "pretend" he was not aware. I think it was the combined sadness, and the frustration that comes with being mostly unable to communicate with him or help his condition...
He had previously made his DNR request very clear, which made things even more painful for his children and wife, in that they basically knew that they were helplessly watching him die, very slowly.
At some point, his kidney function began to decrease significantly. This coincided with one of the my few visits with him (I lived several hours away from the facility he was in). The nursing home staff were adamant that someone "make a decision" regarding whether to send him to a nearby hospital for dialysis. The room was a thick coagulation of hopelessness, despair, helplessness, and a frantic confusion...
Aunts and uncles were speaking past my grandfather, at each other "How can we decide? Is it an emergency measure? Would he want it? What do we do?" all while he drifted in and out of a very tense and muted state of consciousness.
I don't fault any of the family, but I'd had enough. I moved everyone into the hall: "He is still there, and when he is awake he is lucid and can understand. Please respect that, and stop commiserating at his bedside over this - if you'd like, I will ask him."
It was obvious that they never even considered that.
I knelt at his bedside, and took his weathered hand in mine. He was awake, and looking at me. "Your kidneys are failing, Grandpa" I said, and he nodded. "If you do not have dialysis, you will not live very long." He nodded and squeezed my hand. "So, I want to know if you want to have dialysis or not" and he said "No."
I said "OK, I heard you say no. I want to make sure. You know that if you don't have dialysis then you will die very soon."
He nodded, and barely formed the mumbled words "I am ready to die."
I think back on this time and I still break into sobs at how much I miss that man. At the time, all I could think or feel was my love for him, and how much he deserved to still be treated with love and respect. And while I'm very glad that I did it, its still hard for me to believe that I was able to.
I love you, Grandpa, thanks for everything.