Karla's Kolumn: Barbara Bush lived life her way, even at the end

Former First Lady Barbara Bush passed away Tuesday. She has always been one of my favorite first ladies. She was classy but down to earth, not afraid to speak her mind and live life her way.

She accomplished a lot in her life, including as a wife, mother, grandmother and first lady. She lived life on her own terms even at the end.

You may not agree with what I'm about to say and that's OK, but it needs saying. I'm glad Barbara Bush has gotten the conversation going on comfort care at the end of someone's life.

It always seems to take a "celebrity" to move discussion along on sensitive topics – Magic Johnson with AIDS, Michael J. Fox with Parkinsons and now Barbara Bush with comfort care.

In an article by Kaiser News via the Associated Press, the Bush family last Sunday had announced that Barbara Bush decided "not to seek additional medical treatment and will focus on comfort care" for her COPD and congestive heart failure.

The announcement, according to Kaiser news, comes "amid a national effort to define and document patients' wishes, and consider alternatives, before they are placed on what has been described as a 'conveyor belt' of costly medical interventions aimed at prolonging life."

According to the article, Ellen Goodman, co-founder of the Conversation Project, which encourages families to discuss and document their end-of-life preferences, applauded the Bush family announcement. "It sounds like this forthright, outspoken woman has made her wishes known and the family is standing by her," Goodman said.

Dr. Joanne Lynn, director of the program to improve elder care at Altarum Institute, was quoted in the article stating, "It makes perfectly good sense at her age, with her failing health, that she would say at some point, 'Life's been good, and while you always want more, it's enough.'"

And, Dr. Lynn is correct. It is OK for people when they come to the end of their life to say "enough." It's OK to choose quality rather than quantity of life.

The Kaiser Health article continued, Dr. Haider Warraich, a fellow in cardiovascular medicine at Duke University Medical Center and author of the book "Modern Death," also applauded the Bush family for putting the phrase "comfort care" into the public sphere so that other people can consider it "a viable option at the end of life."

But he said the family statement also creates confusion about the meaning of "comfort care," by suggesting that it entails stopping medical treatment. On Twitter, palliative care experts vigorously refuted that mischaracterization.

"Comfort care" usually refers to palliative care, which focuses on managing patients' symptoms to keep them comfortable and retain their dignity, Warraich said.

"One of the common myths about palliative care is that they are being denied medical help," Warraich said.

For heart failure patients, he said, "comfort care" usually means opting not to use a breathing machine or CPR. But patients do continue to receive medical treatment, including morphine to ease shortness of breath, and diuretics to remove excess fluid from their lungs, he said.

Living, lying on a bed, hooked to tubes and ventilators, is no life, in my opinion. So choosing comfort care is a wonderful option for people who want, as Barbara Bush did, to say "I have lived a good life but it is enough."

No one else should make that choice for us. We need to make that choice and should make it prior to that emotional time when the time is near.

Monday, according to Kaiser Health article, was National Health Care Decisions Day, a day so designated the past eight years. Monday has past but it is not too late to consider those life choices and make sure they are known to your family.

My husband and I have discussed this for years and we both know exactly what the other wishes. If and when the time arrives, we, like Barbara Bush, will choose comfort care.

IN HER OWN WORDS

During this week a lot has been said of former first lady Barbara Bush, controversy over some of her comments, some she regretted like when she called Geraldine Ferraro on the campaign trail a name "that rhymes with rich." (She later apologized to Ferraro.) There's controversy over the Fresno State professor who called her a racist and was glad she had died.

And social media is being filled with memes from some of her more memorable quotes, including several from her famous speech at Wellesley College in 1990.

Excerpts from the speech provided by the AP and show that the quality of life was more important to Barbara Bush than the quantity. May we all choose quality of life.

Barbara Bush, in 1990: "And early on, I made another choice, which I hope you will make as well. Whether you are talking about education, career, or service, you are talking about life and life really must have joy.

"It's supposed to be fun. One of the reasons I made the most important decision of my life, to marry George Bush, is because he made me laugh. It's true, sometimes we laugh through our tears, but that shared laughter has been one of our strongest bonds. Find the joy in life because as Ferris Bueller said on his day off - 'Life moves pretty fast and if you don't stop and look around once in a while you are going to miss it.'

"The third choice that must not be missed is to cherish your human connections, your relationships with family and friends. For several years you've had impressed upon you the importance to your career of dedication and hard work, and of course that's true. But as important as your obligations as a doctor, a lawyer, a business leader will be, you are a human being first and those human connections with spouses, with children, with friends are the most important investment you will ever make.

"At the end of your life, you will never regret not having passed one more test, winning one more verdict, or not closing one more deal. You will regret time not spent with a husband, a child, a friend or a parent."

May we all, like Barbara Bush, live life, even at the end, on our own terms.