Planning for the end saves much grief
| Monday, May 18 2009 11:20 AM
Last Updated Monday, May 18 2009 11:20 AM
For the California Advance Health Care Directive, visit online: www.ag.ca.gov/consumers/general/adv_hc_dir.php
The booklet itself is available at hospitals or through your doctor.
The Web site for AARP (aarp.org) is also informative.
Recent events in my family have forced me to think about those end-of-life choices that I prefer to relegate to the far-off future. My father was hospitalized with end-stage heart disease, and at one point had been placed on a ventilator and a feeding tube, both of which I believed would have been against his wishes had he been able to decide. He has since recovered sufficiently to breathe on his own, and his heart valiantly struggles to continue beating against tough odds. He is currently, and rather miraculously, in a rehabilitative center, with the goal of getting strong enough to come home.
The crisis that led to my father's hospitalization was grim enough that his doctors had requested a decision on whether my mother wanted to place a "Do Not Resuscitate" order in my father's medical chart on his behalf. This meant that, if his heart stopped beating, they would let him go. The staff had performed heroics earlier, including shocking my dad's heart with a defibrillator and putting him on a ventilator because he was turning blue, due to the absence of such an order. In the event of another "episode," as they called it, they would be required to repeat the lifesaving procedures, even if they personally felt it would be against my dad's own desires. The doctor who knew him best recommended a "DNR" as opposed to an "R".
My mother was not crazy about the idea.
But now my dad is alert and able to decide such things for himself, as laid out in the California Advance Health Care Directive. This booklet gently takes a person through the decision process regarding end-of-life medical care, although its cartoonish illustrations and accompanying text that's written at about a fourth-grade level seem incongruous with its subject matter. The person filling out the form can choose a health care agent to make decisions if he or she is incapacitated, and can spell out specifically what life-saving measures are to be used in the event of a health crisis, such as CPR, dialysis, a feeding tube, a ventilator, or blood transfusions. There is also a page to provide direction about organ donation or an autopsy in the event of death. The form must either be witnessed by two other people, or notarized. A further wise requirement is that neither witness can work as the health care provider, and one witness must be someone not related in any way to, and not a financial beneficiary of, the person signing the directive.
A few weeks ago, I found myself sitting in the dim critical-care hospital room alone with my dad. Machines with digital read-outs of my dad's vital signs were beeping, his lungs were inflating regularly, and fluids were dripping into tubes both entering and exiting his sedated body. In spite of the mechanical noises of the business of sustaining life, it was momentarily peaceful. My mother and sisters had left for the evening, and I had a little time before I had to go to the airport to pick up my brother.
It occurred to me that our family has enjoyed far more blessings than we could ever count. We've had such a good, long run. My dad's heart seemed to be nearing the end of its ability to function, but it was a mighty heart. In spite of his pragmatic exterior, my dad had helped out probably even more people than the ones we knew about. He may have sometimes had the sensitivity of a toad, but his heart always went out to those who needed him. He'd become more sentimental with age, but he'd always secretly been a little mushy. I mean, he grew roses for a hobby. Fantastic, fragrant roses.
It also occurred to me that one's attitude about authorizing a "DNR" order for a loved one is perhaps colored by one's faith or lack of faith in an afterlife. I did not question that the DNR respected my father's wish for dignity and class both in life and at its end. I believed that my dad's soul would live on after his human body perished, both with God in eternity and his essence in the finite hearts of all those who had known and loved him. But then I began to doubt myself. Maybe it wasn't my faith that helped me feel at peace with having those three fateful letters written in his chart: maybe I was deep-down just a cold-hearted witch who wanted to get my dad's life over with already. Clearly, the DNR decision is laced with second-guessing. Just as clearly, fatigue and stress do not enhance self-knowledge. I had a good cry, and then left for the airport.
As my dad now makes his own decisions about his future, which I will support no matter what they are, because they are his, I too am filling out the Advance Health Care Directive. My husband and I are talking about our wishes and expectations of each other in the event of a tragedy, as are other members of my family. It's not the most lighthearted or pleasant conversation to have. But it may one day be the most essential.
