After spending months of horror in the hospital to treat cancer, my grandmother instituted a Do Not Resuscitate order. She had endured 80-something years on earth and survived the Nazi occupation of France, but after a hip replacement and cancer treatment, she’d be damned if she spent more time in the bloody hospital. She said she was tired, and she was done.

When she went into septic shock and coded at the hospital from an infection that had spread from her hip replacement into the rest of her body, the relative who brought her into the hospital panicked and insisted they resuscitate her. While that got my grandmother’s heart beating again, she did not regain consciousness. When the rest of the family arrived, distraught over my grandmother’s wishes not being followed, they endured a terrible couple of days of deliberations related to her care. Should they honor her wishes and let her die, even though she had been resuscitated  against her explicit order? Or should they continue care and put my 80-something grandmother into the exact situation she had nightmares about – six months to a year of treatments and rehab in the hospital to replace both her hips again and pump her full of antibiotics to clear the infection?

By all counts, it was a bitter conversation. My grandmother had five children, and they all had an opinion. In the end, it was decided that they would honor her preference and let her pass on instead of trying to extend her life against her wishes.

While I sat in the surgery room with my dog Drake yesterday with my spouse, giving the OK to end my dog’s care after eight long months of struggle against an antibiotic-resistant staph infection, I admit I thought of my grandmother. You hear a lot that care for animals and people is different. People have souls, or people are smarter, or people are people, and animals are animals, but I have heard that refrain before, and it’s generally from people who are trying to Other someone so they can feel better about their awful treatment. How many foreign cultures call those of other countries or races animals to justify what they do to them? We don’t like giving sentience to things that we want to murder, abuse, or eat.

So I thought of my grandmother, in part because Drake was also suffering from a horrific case of sepsis after the worst of his antibiotics had eaten its way through his stomach and lower GI tract, causing terrible lesions that were leaking fluid from his gut into the rest of his body. It was a horrible way to be living. But it was either try that or let the infection that had migrated into his spine slowly eat him from the inside out.

No matter what we did, he was being chewed up; devoured. The devourer had won, and I despised myself and the world for that.

Being an adult means making adult decisions. Decisions that have no clear line of right/wrong. The morality is muddied. In the case of my dog, my spouse and I were his caretakers, and he trusted us absolutely to make the right decisions for him. He endured months of treatment because he trusted that we were doing right by him. I have never met anyone more trusting except a very young child. Maybe it was that part that made it so difficult. While there are many dogs who retain their wild doggyness, for lack of a better word, Drake was fully socialized. He wanted nothing more than to please us. All we had to do was raise our voices, and he would cease whatever he was doing. Even his last day alive, he struggled hard to get up and relieve himself outside as he sagged in his harness, because that’s what we wanted of him. It broke my heart.

As I type this, the other side of my family is currently moving my dying grandfather into an assisted living facility. He’s become increasingly deranged and a danger to himself and others. Someone has to make the choice. Someone has to drawn the line.

Being that adult is awful.

I have had to make my own gray moral choices many times before. I’m thirty-six, and I did not get this far by being perfect. There are things that make it easier, of course. We use all kinds of logic to justify our choices. One would think that having more choices would make us happy, but in fact, when you’re an adult and you have more choices, it just makes you miserable. You will always doubt. You will always wonder. Was it really a gray choice or did I just not recognize the right choice from the wrong one? Why wasn’t it obvious? There have been studies done of parents who received this awful choice: your daughter is born prematurely, but has a 90% chance of dying within a few months from organ failure. Do you continue care? Parents in places like France, where the doctor previously would make the choice, felt awful in the short term but better in the long term, because they didn’t have to live with the choice. In the U.S., parents who were presented the choices as if they had equal chances of success felt the absolute worst in the moment and in the long run. Those who fared best, long-term, were the ones who were told the choices and then given the doctor’s recommendation. Being overwhelmed by adult choices doesn’t make us feel better, but worse. Sometimes it makes us feel so bad that in cases where we don’t need to make a choice at all – like buying jam – we choose to do nothing instead of make a choice, fearing that whatever choice we make will be wrong.

But in big life decisions, there are very rarely do-overs. There are very rarely instances where you don’t make a choice. Choosing a new job opportunity is making a choice between the unknown and the status quo. Choosing to finish a novel is choosing between having a novel and the status quo. We are constantly choosing, as adults: the status quo, or the unknown? And then these, the worst choices, the gray choices, which are not always life or death, because eventually every one of our choices leads to that ultimate end, to death. Instead these choices are to continue care in the hopes of extending life, or ending care and letting the inevitable come a little sooner.

Gray choices. Hard choices. Shitty choices. Adult choices.

Folks often wonder why I write such gray, conflicted characters who have impossible choices. But the truth is that being an adult is full of impossible choices. As a kid you often have other people’s choices thrust upon you, which creates its own sort of horror. But as an adult you don’t get to say, “That was someone else’s bad decision.” As an adult, you have to live with it. While most of us are very good at rationalizing our choices (we would die of regret otherwise, and yes, some still do), you still wake up at 3 a.m. sometimes, as I did last night, wondering what the point of it all was, and why fight when this is always the end, the same end, for all of us, eventually.

And then I get up, and I take the drugs that prolong my own life for a few years more, a few years more, maybe even more yet, and I get back to work. I am lucky to be alive to make these choices, for myself and for those in my care. I know this. But it’s only fair to note that some days all this responsibility feels like a curse, when you’re holding this giant dog’s paw in your hand, this animal who has trusted you absolutely for nearly two years, and you nod, and you say, “OK,” after spending eight months of your life fighting. I am a fighter. I don’t like to give up. But it was not me who had to endure that surgery, a surgery I likely wouldn’t have survived either, with my equally shitty immune system.

Sometimes, when you say “OK,” I think you realize that it’s you on the table, that it soon will be you on the table, and someone else you love and trust will need to make that choice, and you hope it’s the right one.

 

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