By Megan Owen Heaton, LCSW, CCM
We’ve all heard the typical consent speech before surgery: “If you don’t proceed, you risk dying sooner; if you do, we extend your life.” But what if the outcome isn’t so clear-cut? What if the truth lies somewhere in the ambiguous and uncomfortable middle?
Let me introduce you to Esther.
Esther was given the consent speech before her heart surgery three weeks ago. As an 82-year-old woman, thriving, still living independently, driving, and even working part-time, she chose to proceed forward. She was sharp, vibrant, and active. Now, Esther is still sharp but requires a tracheostomy and a ventilator to help her breathe. A PEG to provide her nutrition. A transfer to her “new home,” a long-term acute care hospital (LTACH).
She and her daughter, a constant presence, clung to the hope that Esther would return home. To be back in her recliner, her garden, her routines.
But the days turned to weeks. The ventilator was weaned for a day, then needed to be turned on again. The PEG tube gets clogged, then cleared. Swallow studies brought occasional sips of water and ice chips; another more would be too high risk for aspiration. Physical therapy worked diligently to coax movement from a body that once walked freely but could now stand for only two slow, deliberate steps. Each day brought new obstacles. Each day also brought determination.
Two months have passed. Then three. The recovery was not linear, with one step forward and two steps back. Conversations shifted. What would insurance cover? How long could she stay in a hospital setting? The closest skilled nursing facility was five hours away. Returning home now meant 24/7 care that Esther would have to pay for out of pocket.
Eventually, the sobering realization emerged: Esther would never return to her prior level of function.
A decision had to be made. It took 4,380 hours—six months of relentless effort, small victories, and repeated setbacks. Then, with grace and clarity, Esther made her final choice.
She would say goodbye to the medical intervention that was keeping her body alive. Esther asked her doctor for comfort care, and her doctor agreed to provide it.
She asked for a bite of her favorite food and a sip of her favorite drink. She wanted to be pain-free. She permitted the doctors to remove the tubes and machines. She embraced her family, and in doing so, she gave them the gift of closure. She said, “Enough.”
As case managers, we live in this in-between space. Between cure and comfort. Between hope and realism. Our role isn’t just to coordinate services, but to walk alongside patients and their families during some of the most difficult decisions they will ever make. We don’t push or persuade; we inform, support, and uphold dignity. Esther’s story isn’t uncommon, yet it is deeply powerful. It’s a reminder that medical success isn’t always defined by survival, but sometimes by the courage to choose when to stop.
Join us as we Innovate. Advocate. Celebrate Case Management.
While the official celebration runs October 12–18, we’re recognizing case managers all month long with inspiring education, CE opportunities, valuable resources, networking events, prizes, and more. Let’s honor the vital work of case managers and the impact they make every day! https://cmsa.org/about/national-cm-week/
Bio: Megan Owen-Heaton, LCSW, CCM, is a passionate social worker of 20+ years. Her work has expanded from a Peace Corps Volunteer, working with people with disabilities and medical social work. She finds that having the ability to advocate and educate patients & their families rewarding and challenging with each day bringing new challenges. Her free time is spent with her 14-year-old dog Honey, listening to music, eating good food, and traveling.