Wednesday, July 19, 2006

Things we don't like to think about until we have to .. but then it is usually too late.

I will be the first to admit guilt..that while this comes up from time to time, I do not like to think about this either. I hope that after sweetie and I are settled into married life, that when we look at the important papers, this will be one of them. Advanced Health directives or DNR orders or living wills, as people call them, are important for everyone. But no one wants to write one. It's that "what if" that no one really wants to think about... like "what if ... I had an amputation, what if I lost my job, what if my spouse left me, what if I was told I had a fatal diagnosis and there was no cure...." No one really wants to face this, until we do. It is things like a funeral, or some other story in the news that sparks our thoughts on "that which we do not wish to think about ..." . Sometimes it is easy to turn off the TV and think about something else, and at other times we can't. The Terry Schiavo case sparked great debate on a national and international level. Where I work in the hospital I see/hear horror stories of 70 or 90 year old patients brought in yet again, and because there is no health directive, they are given CPR (a procedure that can be long and actually breaks ribs..) and are intubated. "Is this what Grandma/mom wants?" To be kept alive on a respirator, and when/if she wakes up will have to go through pain and struggle through rehab. Would she want this? Maybe she does.
In the end, I think it comes down to one question. At what point, do I think that my quality of life will suffer? How much pain is too much? At what point do I stop enjoying my life?
There are different levels of intervention. i.e comfort care only, intermediate care, or full treatment. There's even different ones if you are in the community versus a facility.

So if someone does not have an advance directive, and let's say they have a bad stroke or a car accident and it doesn't look very good for the outcome, the family is often asked what to do. In ICU, this often is the case. We (medical team) aren't asking you (family) to "pull the plug". In the end, it is the medical team that determines the prognosis and the course of treatment. But if it looks good for recovery but the patient will have severe to moderate side effects/trauma, it may be that the individual would not want to live this way. Although there is nothing on paper, someone might know that this is what s/he wants. Or it may be that family are in too much shock to process what is going on. The written directive is a guide to medical team, is a way for a person to speak when they verbally aren't able to.

True, there is always a chance that things change. That the person thought one thing but when a trauma hits they change their minds. Like my lady who died in February. She was a very strong personality, but when it came down to it. She said "you know, despite what I seem to say.. I have decided that this pain is too great for me. That living this life of dialysis every other days, not sleeping in a bed because I'm in pain... I've decided enough is enough. This is no life for me." Or when you decide you would rather not be resuscitated, you may have the "near-death" experience and decide that you aren't ready to meet your Maker. It is possible, but then, isn't it still better to think about these things before you really have to.. and then it is too late?

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