At the Hands of an Angel

On November 23, 2013, my 91-year-old mother walked into the hospital with a dangerous blood clot in her leg. At the time, she was also suffering from dehydration, which likely affected her mental acuity.
Upon admission to the hospital, she was asked to sign an affidavit stating that she did not want extreme medical intervention to preserve her life. She signed the document. But the next day, after she had received intravenous fluids and her mind was clear, she asked to retract that statement.
The hospital didn’t accept her retraction. The doctor assigned to my mother, a non-religious Jew named
Dr. David Oppenheim, operated on her and successfully removed the blood clot. The surgery weakened my mother considerably, however, and she was unable to eat or drink anything in her
postoperative state. The hospital attempted to insert an NG feeding tube through her nose, but she was extremely uncomfortable and pulled it out. This meant that the only nutrition she was receiving was
glucose and water, by IV. A person can’t live for very long on only glucose and water, though, especially when that person has just undergone surgery and her body needs to heal and recover.

As the days and weeks passed with my mother allowing hardly any food past her lips, my siblings, Chaim and Tirtza — who lived in the same city as my mother and were taking turns at her bedside — grew increasingly alarmed. Hearing the worry in their voices, I decided to fly in from abroad. What I saw when I entered my mother’s hospital room shocked me.

Prior to her hospitalization, my mother had been almost completely independent. She’d cooked and cleaned for herself, moved around easily with a cane, and was in full possession of her mental faculties.
My mother had always been a fighter. She was 18 years old when the Germans invaded her city, and she survived the war by escaping to the mountains and living as a partisan for three years. She never talked about that period of her life; she just moved on and rebuilt. She came to America and married my father, and the two of them worked themselves to the bone to raise a family and earn a living. She was an extremely intelligent woman, fluent in seven languages.

Seeing her lying in a hospital bed, pale, lethargic, and barely communicative, hooked up to tubes and wires and machines, I couldn’t believe this was my mother. Medically, there was nothing
wrong with her; the problem was that she was wasting away due to lack of nutrition.
My siblings and I took turns at her bedside, coaxing her to eat and drink. “Mommy, have some applesauce,†I’d say. But the most we could get her to eat in a full day was three or four teaspoons of applesauce, and maybe half a cup of juice.

“My mother isn’t eating,†I told the nurses repeatedly. “Oh, don’t worry, honey, she’s eating,†they assured me each time. “The aides are getting her to eat.†They were? When? Between midnight and six a.m., the only hours my siblings and I didn’t spend in the hospital? Chaim, Tirtza, and I sent Dr. Oppenheim multiple e-mails — signed by the three of us — pleading that a PEG feeding tube be inserted into my mother so that she could receive adequate nutrition. We never received any response.
Finally, I went to Dr. Oppenheim’s office and asked to speak to him. “Dr. Oppenheim is doing his rounds,†I was told. “Fine,†I said. “I’ll wait here for him.†I sat down in front of his office and started saying Tehillim.

When Dr. Oppenheim finally returned, I stood up and introduced myself. “I’m Judith Caplan, Mrs. Feiner’s daughter. Can I speak to you?†“Sure,†he said. “Come into my office and have a seat. What can
I do for you?†“I’d like to request that my mother receive a PEG feeding tube,†I said politely. “She’s getting excellent medical care, but without proper nutrition, she can’t possibly recover.â€
Dr. Oppenheim leaned back in his chair. “You know your mother is going to die,†he murmured.
I was stunned. “Are you the Angel of Death?†I retorted. “How can you say that she’s going to die? She was healthy and independent up until a few weeks ago, when she entered the hospital.â€

“There’s nothing I can do for her,†he said, waving his hand. “She’s 91, you know.†“And that means her life isn’t worth living?†I asked incredulously. “Dr. Oppenheim, if this was your mother, you wouldn’t do everything to help her live?†His gaze was impassive, and he didn’t respond. It was time to up the ante on this conversation. “If you don’t give my mother the PEG she needs,†I said firmly, “I might have to sue you.†Dr. Oppenheim cocked his head. “Are you threatening me?†“Take it however you’d like,†I said. That was the end of the conversation.

Dr. Oppenheim’s attitude was shocking. But what was more shocking to me was the reaction of the people in the community. On Shabbos, I attended a parshah shiur given by a local rebbetzin.
After the shiur, I requested permission to address the women in attendance, most of whom were in the 50 to 70 age bracket, women I had grown up with. “Ladies,†I said, “your children don’t live here. The younger generation has moved away, and they won’t be here to advocate for you when you get old. We have to do something to change this situation! We can’t allow the doctors to play G-d and decide who
deserves treatment and who should be left to die!†The response was utter apathy. “There’s nothing we can do,†some of the women said, echoing Dr. Oppenheim’s words. “This is the health-care system.â€

Apparently, no one was willing to stand up to the almighty health-care system and challenge the doctors’ right to decide who deserves treatment and who doesn’t. Next, I approached the head nurse of my mother’s ward. “My mother is not eating, and she’s dying in front of my eyes,†I said. “I’d like to request an ethical board meeting.â€

The meeting was duly scheduled for 11 a.m. the following day. In the meantime, I called Rabbi Zuckerman, a leading rav in the community, and asked him if he could attend. He agreed. I also called an askan in the community named Rabbi Lehman, who had been very helpful to us throughout this ordeal, and he promised to participate as well.

Shortly before the meeting was supposed to start, I received a message that Dr. Oppenheim had to postpone the meeting to 11:30. I immediately contacted Rabbi Zuckerman and Rabbi Lehman and informed them of the delay. When the meeting was postponed again, to 12:30, Rabbi Zuckerman’s secretary regretfully informed me that the rav had another appointment at 1:00 p.m., and would not be able to come. In the meantime, Rabbi Lehman arrived, as did Myra, the head of the hospital’s ethics
committee, and the three of us sat in the glassed-in conference room, waiting for Dr. Oppenheim.
At about 12:30, I spotted Dr. Oppenheim through the glass. He was walking up and down the hospital corridor, absorbed in his thoughts. Clearly, he wasn’t very interested in this meeting. I watched him pace for a while, and then I turned to Myra and asked, “Can you please ask Dr. Oppenheim to come in?â€

Myra exited and motioned to Dr. Oppenheim to enter, which he did, reluctantly. When the meeting commenced, I repeated my request for a PEG for my mother. “Your mother is going to die,†he reiterated. “There’s no point.â€
“How about giving her a TPN, a nutritional IV?†Rabbi Lehman suggested.
“Too expensive,†Dr. Oppenheim said. “Not justified. Besides, Golda Feiner signed an affidavit stating that she doesn’t want extreme life-prolonging interventions.â€
“It wasn’t too expensive to operate on her, but now it’s too expensive to give her a PEG
feeding tube?†I exclaimed. “And giving basic nutrition is an extreme intervention?â€
I stood up from my seat. “My mother specifically requested to retract her signature on the affidavit,†I added. “Why wasn’t that request honored?â€
“She’s not in full possession of her mental faculties,†came Dr. Oppenheim’s answer.
“Now she’s not,†I agreed. “Who would be, after not eating for weeks? But when she asked to retract her signature, she was fully lucid — more lucid than she was when she signed the affidavit.â€
“Please excuse me,†said Dr. Oppenheim. “I need to be seeing patients now in my office. Mrs. Caplan, your mother is 91, and she no longer has any quality of life. I understand your attachment to her, but logic and good sense have to prevail here. Good afternoon to you.â€
As Dr. Oppenheim departed, with Myra following him, I turned helplessly to Rabbi
Lehman. “This is how it is,†he said, shrugging his shoulders in defeat. “There’s no use arguing
with the doctors. It always boils down to money and quality of life.â€
“Can we move my mother to a different hospital?†I asked in desperation. “Maybe a
Jewish hospital would be better?â€
“No hospital is going to accept her as a transfer patient in this condition,†he replied.
“But trust me, Mrs. Caplan, it’s the same everywhere. I’ve seen this scenario play out countless times in every other hospital in the city. There’s no point in fighting it.â€
“There’s no point in fighting it?†I asked incredulously.
I was at a loss for words. How I wished Rabbi Zuckerman could have been at the ethical board meeting to articulate the Torah’s position on sanctity of life. But thanks to Dr. Oppenheim’s dillydallying, we did not have the benefit of the rav’s presence.
“I’m going to get a lawyer on the case,†I told Rabbi Lehman.
“Good luck to you,†he said. “You’re going to have a really hard time proving that the hospital is acting in opposition to your mother’s express written wishes.â€
“I don’t care how hard a time I have,†I said quietly. “I have to do whatever is in my power to save my mother. If I don’t succeed, that will be Hashem’s Will. But if I don’t try, I’ll be guilty of standing idly by while my mother’s lifeblood is being sucked away.â€
That afternoon, my siblings and I sent another e-mail to Dr. Oppenheim — this time with a copy to the ombudsman of the hospital. That very day, we received our first-ever response from him: “I do not transmit patient information by e-mail. If you wish to discuss your mother’s care we can meet on the ward or speak on the telephone. There is no point in sending me several e-mails a day.â€

We hired a lawyer to represent us, and he sent a letter to Dr. Oppenheim, to the hospital’s medical ethics committee, and to the hospital ombudsman formally stating our objections to our mother’s treatment — or lack thereof. The letter concluded by stating that unless our mother was given a PEG or reasonable equivalent, we would take our case to court. “The hospital cannot permit a patient to effectively die of
hunger when a means of treatment is available,†the lawyer wrote.
Wonder of wonders, immediately after the letter was sent, a group of doctors convened in my mother’s hospital room to discuss her condition. Chaim was there at the time, and he told me that the doctors had approached him respectfully and asked,
“Mr. Feiner, what can we do to help your mother?â€
“She needs a PEG feeding tube,†he said.
“Okay,†the doctors replied. “But before we can have the PEG inserted, we need to check her kidney function.â€
That exchange took place on a Thursday. It took until Tuesday for the hospital to finally check her kidney function — another five days in which my mother was subsisting off glucose and water only. On Tuesday, the doctors decided that she needed dialysis before they could insert the PEG. She never did get the PEG, because during her second dialysis treatment, she passed away. She had lived for two months on IV sugar water — longer than most other people her age would have lasted — but eventually, her body gave way to starvation.

I cry as I write these words, because even if my mother was destined to die precisely when she did, she should not have had to die such a cruel death. She didn’t just die — she was the victim of passive euthanasia. And this took place in 2013, in a prestigious, university-affiliated hospital that considers itself “compassionate†for not “unnecessarily†prolonging the lives of its elderly or incapacitated patients. Hospitals today are very busy with patients’ rights, including the “right†to be denied medical intervention. I’d like to reinstate another “rightâ€: the right to die at the hands of an angel, and not at the hands of man. —
L’illui nishmas Golda bas Tcherna