What would you do with an 89-year-old woman who walks with a walker, and you find in “a fib” two years after her last ECG?

I might not thin her blood.

And just a year later when a big clot floats from her atrium into her brain, leaving her speechless and stumbling, uncertain?

I would thin her blood.

And when she falls in the night, breaking most of her ribs, with a pneumo and hemo that need daunting tubes to empty her chest?

I would stop the blood thinner.

And when her leg then balloons from her 12 days in bed, Tied to her wheelchair, Awash in her fear and confusion?

I’d restart the blood thinner.

And if she were your mother?

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Dedicated to my mother-in-law, who died April, 2016, 8 months after her large aphasic stroke.  As a teacher, I wanted to share some of the challenges we had in deciding what “comfort-based” case would look like for her.   I imagine my answers would have been much more confident if I were quizzed as a student.  But as family, there was still that schizoid aspect to our decisions as we chased each episode in her decline and tried to do best by her.   It probably made it worse that both my husband and I are in healthcare.  A wise hospice nurse finally said that blood thinners would not affect her course at the end, and we did not restart blood thinners for that swollen leg that didn’t even seem to concern her.  She died two weeks later.  

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