Thinking and Planning Ahead

This has got to be one of the best times of the year. Here in Denver the sun is shining, the days are pleasant, the flowers are in bloom, and the birds are singing. The stock market is doing great, with regular record highs. It’s vacation time for many and even city traffic is light. I wish the good times could go on forever.

Meanwhile over in Georgia, my daughter’s grandfather-in-law was dying. She asked if the sparse amount of water he was able to consume was likely to extend his life. It was not. I asked if he had an advanced directive or medical decision-maker. He did not. Georgia is down one good man.

Like it or not, our time on earth is limited. If circumstances or fate leave us unable to express our wishes later in life, then someone – who may not even know us – will make those decisions, and their decisions might not be what we want. While it’s important to let our wishes be known and to choose our back-up medical decision-maker, it is also NOT a conversation that most individuals enjoy.

Fortunately, there is some help and encouragement. The encouragement comes from perhaps the least likely of places – physicians. Most docs choose quiet deaths that maximize quality time with family and fewer heroic measures (link below). Docs and others in the medical professions recognize the limitations of medicine. Yet patients who can not and have not expressed their wishes receive pretty much all possible care, however futile.

The help comes from organizations which have made it easy to consider your choices. They are YOUR choices. Advanced directive forms or the Five Wishes program (each linked below) will walk you through decisions that you should consider and document. If you are not comfortable reading through forms, ask your health care provider or a friend to help you. You can always ask your pharmacist to direct you to someone who can help.

Start by designating a medical decision-maker who understands your wishes, is able to communicate with a health care team, and who will stand up for what you want. We think that our spouse or family members will know exactly what we want. Often, family members interpret a patient’s wishes through the lens of their experience with the patient as spouse, sibling or parent, and it’s easy for family disagreements to arise under stressful conditions. Advanced planning minimizes family discord. Your designated decision-maker speaks for you.

Advanced directive forms document some of the major patient decisions regarding life support, such as being put on a ventilator. Other programs, such as The Five Wishes, encourage expression and discussion of what each patient wishes toward the close of their life.

My mom died about 18 months ago. I was her medical decision maker and helped her receive exactly the level of care that she wanted (in addition to providing other amenities, of course). She suffered from aortic stenosis, an aortic aneurysm and heart failure, and throughout her journey she was able to express her wishes. Nevertheless, some docs relentlessly pushed certain procedures. She was pretty tough for a 92- year old, but as her medical decision maker I felt I had to protect her from being bullied. It was helpful for her that she had considered end-of-life decisions and had her paperwork to show it. She declined some drugs and procedures and accepted others.

It was a great loss when she died suddenly, just as the sun rose on a beautiful December morning. There is very little comfort to be had when someone close passes away, but knowing that we’ve done what we could to help them live and die as they wished is at least a small comfort.

You can help yourself and give your family that peace and comfort when the time comes. So, take a little time during this beautiful Summer to think about the Fall and Winter of your life. Take care of yourself.

Wall Street Journal (2012) Why doctors die differently

AARP Advanced Directive Forms

Five Wishes – an advanced planning program (costs about $5)

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