Well, this has been my call weekend. It has been not to bad. Friday, I worked in our Emergency Room for a twelve hour shift, and then the remain two mornings I have gone in and made hospital rounds for the groups inpatients. Add, picking up Ella from camp, making it to Sunday night service, feeding the cattle in between rain showers on Saturday, picking up around the house, and a few other things and you get the drift of my weekend.
This weekend like every weekend I am on call, at some point I have to face a life and death situation. That brings me to my topic, a difficult conversation. There is nothing harder on me as a doctor then having to walk into a room for a patient that I am not their regular doctor and have to talk with them about end of life care. But, it seems that every weekend, it is a conversation that keeps repeating.
I have faced this conversation from both sides of the health care coin. When my grandmother was wasting away from dementia, she eventually forgot how to eat and drink, along with me and everything else, I had to make the end of life decisions about her health care. But, unlike most of the families I talk too, my grandmother had made a living will with very specific end of life care plans for me to follow. Even with her wishes spelled out, watching her waste away was never easy. I still wonder at times did I do the right thing.
I don’t have the answers for ever patient as they face the end of their time on this planet. Nor do I think that as the doctor, should I have the answers. I can offer guidance, medical facts and statics, and information about a particular medical case. I can pray, cry, listen to tales of better times or hopes for a reunion among angels. I can grieve with families uncertain of a loved ones fate. But, the only thing I can guarantee as a physician, who has had a lot of end of life talks with a lot of families and patients, the only way to guarantee your wishes is to write them out, tell your family, have a living will, and talk to your doctor in advance. Believe me, it is better to have some planning months to years in advance for end of life, rather than waiting till an emergency arrives in a hospital setting where you may not be able to speak for your self. And if your state is like mine, if you have no stated end of life care plan, then we as health care providers must do everything within our power to resuscitate you.
Having a good working relationship with your doctor means you can talk about all aspects of your health, even those hard discussions that none of us want to think about, the last plan. When a doctor broaches the subject of do not resuscitate (DNR), that conversation can be as hard for them as it is for the family. Also, DNR does not mean not to treat, it just means that if death occurs we do not try to reverse the occurrence. An easier way to think about the DNR is to Allow Natural Death (AND). To be able to make health care decisions for another family member you must either be their closest living relative or have a durable medical power of attorney. (And remember, durable medical POA only come into play, if the patient in question is no longer able to make medical decisions for themselves.)
- To resuscitate or not to resuscitate: is that the right question? (boston.com)
- Volatile issues surrounding end-of-life care remain unaddressed (buffalonews.com)
- The Takeaway: Hospices Diversify End-of-Life Care to Suit Boomers (aarp.org)