Monday, April 25, 2011

Your Life Your Choices - Making Your Wishes Known

Alice at 93 knew she was a problem for her sons, but she was not about to leave her beautiful family waterfront home on Lake Washington. She could pay for part time help, shopping and gardening. She loved her privacy and having control of her environment.

She knew that the aortic valve in her heart was very narrow. She had refused a new valve for the last 15 years. But it was now catching up with her. Suddenly one day, she went into acute pulmonary edema. Basically, due to the narrowed outlet valve from her heart the blood backed up into her lungs causing acute shortness of breath. A neighbor rushed her to the ER where she was able to be stabilized without being put on a ventilator. On discharge from the hospital, the doctors met with her three sons and let them know that this scenario of pulmonary edema could recur at any time. Plans needed to be made.

Alice was quite clear that she didn't want CPR, heart shocks or a ventilator. "Boys, I've lived a long life and am ready to kick the bucket when my number's up. I don't want any bells and whistles. Just TLC."

Her sons urged her to have a permanent live in care giver if she wasn't ready for a long term care facility. Or better, to come and live with one of them. As expected she replied, "Listen, this is my life and I get to choose what I want." This left the family which now included three daughters-in-law, 12 grandchildren, and 15 great grandchildren in a quandary. How can she get her wishes and still be safe.

Alice reviewed her Living Will and confirmed her choices for no "heroic" measures. One son was appointed her Durable Power of Attorney with the other two as alternates. But how was this really going to help if 911 was summoned?

They met with Alice's family physician and a social worker to come up with the plan. Alice and her doctor completed and signed a POLST form (Physician's Orders for Life Sustaining Treatment). In Washington State this form is a bright "yucky" green and easy to spot. A set of standing medical orders, this form is honored by Medics, ER's, hospitals, and nursing homes. The POLST form travels with the patient thus essentially putting Alice's wishes in a confirmed medical text.

But what happens if Alice can't breathe and 911 is called again? After contacting the Fire Department and speaking to the Medics, a plan was finalized. She wore a "panic button" around her neck which would summon emergency care. The Fire Department kept a copy of the POLST form in their electronic data base, and arranged for Alice to have a "lock box" on her door. This would allow the Medics to enter her house without breaking the door down. For good measure a copy of the POLST form was given her doctor, the closest ER, and several copies were posted around her house. Alice smiled as she spoke to her family, "Now quit worrying, I may live forever!" They still call and check on Alice twice a day. Alice doesn't think all the fuss is necessary.

1 comment:

  1. Dr. deMaine, I appreciate viewing your blog given that I recently completed a research paper on end-of-life care. During my research, I discovered that on 10-29-10, President Barack Obama proclaimed November as National Hospice Month. Hopefully, the proclamation will encourage end-of-life care discussion and promote awareness regarding advance directives. While so many people may be confused by the process of completing a Living Will, your entry today not only educates the public and simplifies the process, but also encourages people to become a self-advocate when managing their end-of-life care. I am especially delighted to find this blog written by a physician, given that I am an RN currently working a hospital. I admire your philosophy and connection with your patients while it appears the topic of advanced directives is usually presented by nurses. Thank you for educating and empowering the public. I look forward to viewing your future posts.

    Best Regards,

    Vickie Vines, RN

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