Who decides for you?
People have asked me some funny questions, but I was taken aback recently when a fellow church parishioner asked me about my work as a VA hospital chaplain.
“Do people die in your hospital?” he asked.
“Well, yes,” I said, “even though we’d prefer they’d not.”
He asked because, as we sat in church, he couldn’t imagine anyone dying. My friend shares a problem most of us have: We can’t imagine the possibility of our own death.
Several years back, I was working in another hospital when a 60-year-old man arrived by ambulance. He had been ignoring chest pains the entire day until he finally collapsed.
Our patient arrived in ICU breathing on his own, but he had waited too long to seek help. Decisions had to be made and his adult daughter arrived in time to make them.
“Does he have an advance directive?” asked his doctor.
He did not. Our patient, like many people, had failed to ask himself the questions contained in an advance directive (also called a living will).
An advance health care directive is a document that “directs” doctors to follow the wishes of patients unable to speak for themselves. Without the directive, doctors are obligated to do “everything” possible, even if that means a painful delay of death.
With his failing breath, he begged his doctor to do “everything possible.” Unfortunately, if the doctor had done “everything,” he would have placed our patient on the indefinite support of a respirator. Since the entire right side of his heart was dead, the respirator would have only suspended him between life and death.
The doctor told the daughter that her dad was unfixable and that if the staff tried anything heroic, her dad would spend the rest of his life on a machine. The woman, realizing that in this case quality of life was more important than quantity of days, stepped into his room and gave her dad one of the bravest speeches I’d ever heard. In my recollection, it went something like this:
“Dad, you know I love you, right? I’ve always told you the truth. Right?”
The man nodded.
“Dad, your heart’s broken.”
“I know,” he huffed. “Let’s fix it and go home.”
“Dad, listen to me,” she pleaded while she stroked his forehead. “They can’t fix this and if they try, you’ll end up on a respirator for the rest of your life. I know you don’t want that, so you need to tell the doctor.”
The father argued. “Yes. They have to fix it. Who will take care of Mother?”
“They can’t fix it. No one can. I’ll take care of Mother. I promise.”
I knew the wind had shifted when the man asked, “Will it hurt?”
“We’re going to make you comfortable, sir,” the doctor softly replied.
I saw the woman lower her head onto her father’s chest and look in his eyes. They exchanged words, then I heard the man say, “OK. Let things happen as they happen.”
With that decision, nurses administered “comfort care” and made sure the man’s final question on pain was answered. That evening, he decided to let go, and the daughter did, too.
To download your state’s advance directives go to www.caringinfo.org.