Peripheral artery disease, peripheral artery disease support
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Gaps and Solutions to Death with Dignity


· Heart of Innovation

This is a Halloween special episode. You might be wondering what ghosts and goblins have to do with vascular disease. It’s not that much of a stretch with festivities around the realm of the dead and for so many with vascular disease feeling like a ticking time bomb, with the weight of it, both physically and mentally. It can be a constant battle throughout the journey with questions that abound about how long they may want to continue to fight for their life as disease progresses. It also raises the question for healthcare teams as to the extent to which they should assist in the fight for life versus starting the process to provide someone with steps toward dignity in dying. It’s especially a tough question for the patient and their family. Show co-host Kym McNicholas starts the show with raising that question from a family perspective prior to expanding the discussion with Nurse Practitioner Kay Smith. NP Kay was not only marked palliative by her care team, but also was designated early on in her career as a clinician helping patients in the United Kingdom to make their transition. In Scotland, she now advocates for those marked palliative to improve laws that support dignity in dying.

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NP Kay piggybacks off Kym’s story about her Mom at the start of the show. Kym’s Mom transitioned this year and she shared her very personal internal battle that continues to haunt her ten months later, as to what more she could’ve or should’ve done to help her Mom. Kym’s Mom was taken unexpectedly by an undiagnosed aortic aneurysm in February. Despite multiple trips to her cardiologist and even to the emergency department in the days and weeks prior with complaints of textbook symptoms, physicians brushed her symptoms off as a lumbar spine issue and simply getting old – but nothing life threatening. Kym keeps thinking, “What if I would’ve known it was an aneurysm, could doctors have saved her with an intervention?” Would she still have her Mom with her today? What would life be like? The only comfort she has is in thinking that maybe her Mom transitioned with more dignity in that she spent her final days ‘living’ and not sitting in a hospital room dying while being poked and prodded with every last effort to save her life.

While Kym and her family can’t change ‘what is,’ she wanted to bring this tough conversation about dignity in living and dignity in dying to the forefront because it is a very real harsh reality facing so many and not discussed near enough. What better time to talk about this topic than around Halloween and Dia de Los Muertos, so as to honor those who have lost their battle with vascular diseases and to help other sufferers find not only an advocate for greater dignity in dying but also dignity in living?

Halloween, or Hallow's Eve, was started to paying homage to the saints, while day of the dead, which is also known as All Souls Day, is considered a day when the dead temporarily return to Earth to be by our side. Tradition has it that the heaven gates open on the 31st to allow the spirits of the children to come back and visit their families for 24 hours here on earth November first and adults come back on November second, known as Dia de Los Muertos. Since Kym’s Mom made the transition this year, it will be a day that she can only hope to feel the presence of her Mom. A guest later on in the show, Felicia, is hoping for the same. Her son transitioned last week after a long battle with multiple comorbidities including Diabetes, chronic kidney disease, peripheral artery disease, coronary artery disease, as well as cardiac valvular disease. In this week’s Save My Piggies segment during the last half of the show, Felicia shares her son Gary’s fight for dignity in living when faced with the choice of dignity in dying prematurely.

Gary and his Mom found advocacy organization The Way To My Heart more than a year ago when he was faced with amputation. He had already had all the toes on one foot amputated due to peripheral artery disease (P.A.D.), a vascular complication resulting from his long battle with Diabetes. He was on deck for a below-the-knee amputation on his other leg when he reached out to the P.A.D. advocacy non-profit to help him find more advanced care. His doctors told him they’d given up on trying to save his leg because a switch in insurance through Obamacare didn’t reimburse their limb salvage efforts so he would be better off seeing another physician and considering another amputation.

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The Way To My Heart was able to facilitate limb salvage for Gary through California Heart & Vascular Clinic’s Dr. Athar Ansari, who took also expedited care for his heart. No one had checked Gary’s heart despite known risk for heart disease and symptom complaints prior to Dr. Ansari. Disease had advanced in Gary’s heart to the point where open heart surgery was necessary by another surgeon to treat his cardiac valvular disease. A pulmonary complication following that procedure resulted in Gary being placed on a ventilator. It was during that recovery process that advocates expressed concern about hospital care, which led to what Nurse Practitioner Kay, with more than 40 years of experience in a cardiac unit and board certified in wound care to say, “It’s the worst back bed sore I’ve ever seen, demonstrating negligible care.” As NP Kay was fighting for better wound care and appropriate accommodations, Gary’s Mom Felicia was approached by his hospitalist and pulmonary specialist who told her it was time to make the choice to turn off the ventilator.

The Way To My Heart reached out to Dr. Athar Ansari, who was not involved with the new hospital care team, to express concern about Gary’s care. He, in turn, reached out to the heart surgeon, who was also surprised by the direction of Gary’s care after care transferred during the recovery process. Together, they were able to convince their colleagues to give Gary greater dignity in life after performing scans that showed continued brain activity. Days later, Gary regained consciousness and started to thrive, even being transferred to a rehabilitation facility. It was in that rehab facility, however, six months later where Gary’s Mom discovered too late that he was not offered standard of care for his diabetes and dialysis. Infection ensued, and he passed away unexpectedly. Felicia shares valuable information during this segment that she hopes will prevent others like Gary from losing their right to dignity in living.