A Nurse Is Teaching The Parent Of A 10-Year-Old Client Advance Directive Warning

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Advance Directive Warning

Saturday, December 18, 2010 at approximately 1:30 am

“I think I need help!”

Mom stood outside my bedroom door, panting and writhing in pain. She said she waited an hour before waking me up.

(Backstory: When I arrived last night, my mom told me she sometimes felt “unwell” at night. Knowing that she had a serious heart attack a few months ago, I prayed I’d be there if it happened again.)

We call 911 and I give them the information. They told me to make sure the pets are safe and the door is open. I said, “I can’t live without my mother.”

About 10 minutes later, I called 911 again. “They’re at the door,” the dispatcher said.

There were two paramedics and four firefighters, including the fire brigade chief. Some provide first aid, others ask about mom’s advance directives. I found it and pointed out it didn’t say don’t treat her.

We arrive at the hospital, a renowned institution for treatment, research and teaching. Doctor C. (cardiologist) and Doctor N. and many other staff members take care of Mom.

They were very concerned about her advance directives. Again, I pointed out that it didn’t say not to treat her unless she was in a coma, which she didn’t.

“She was very ill,” they said. “What does she want?”

I told them through tears, “I know what she wants. She’s a very happy person. She loves life. She’s going to my brother’s house for Christmas. Her great-grandchildren are coming to visit her next month. She doesn’t want to go anywhere.”

I showed one of the doctors part of her advance directive, which stated that she did not want to continue treatment if she was in a coma or vegetative state with no hope of recovery. “She’s not unconscious,” I said. He cast a meaningful glance at her motionless body, hooked up to the machine.

If I had brains, maybe I could say something like, “If they brought in a 20-year-old football player who just had a heart attack and you gave him morphine, how much do you think he’d feel? Yeah? You’d be so fast Just write him off?” But I couldn’t form those thoughts, let alone express them. I just think there is something wrong with the doctor’s reasoning.

They talked about the possibility of surgery saving her life.

I called my brother Jamie and his wife Shirley (a geriatric nurse). Shirley thought her mother would die without the operation. So do doctors. Jamie and I agreed.

Jamie and Shirley arrive at the hospital.

Doctors decided not to operate. It’s too risky. we agree.

N. The doctor wants to discuss options in Mom’s presence. But I’ve read that comatose — or seemingly comatose — patients sometimes give up and die when they hear a negative prognosis.

I said “not in front of her” and we went to the quiet room. C. The doctor again explained that surgery was not an option. we agree.

N. Physician wants to stop treatment (intravenous drug). He told us about an experience in medical school when a professor made a student breathless and recounted his fears. He believed she was suffering and was convinced she would “never regain cognitive function”.

I want her to meet her grandchildren and great-grandchildren, some on the way and some in town. “She wouldn’t know them,” Dr. N said.

“are you sure?”

He sure.

He talks more about how she is suffering. I don’t remember the wording, but I believe there were some indications that she was in a vegetative state.

Jamie and I agreed to discontinue the treatment on the grounds that Mom was likely suffering severe pain and would never regain cognitive function. Just before giving final permission, I turned to Heaven for wisdom and trust that the answer I heard was yes.

They maintained the same dose of blood thinners but lowered the dose of the drug that raised mom’s blood pressure.

[I’m calling what happened next a miracle, but may never know, at least not in this life, how it happened. Perhaps Dr. C. didn’t want to disagree with Dr. N. in front of us, but quietly went ahead and did what he knew was right. Or perhaps–and this may be more likely–they maintained the one medication and only lowered the other one in order to give Mom a quiet passing, without another cardiac event that would clearly upset the family. However it happened, I believe that I heard “yes” not because it was the way to go regarding treatment, but because the answer satisfied Dr. N. and made way for what followed.]

Mom’s blood pressure dropped. We gather together to sing and pray. Mom said through her mask, “I have so much to be thankful for.”

“Thank you for being with me,” she said to each of us—Jamie, Shirley, and me.

“I love you, Mom” ​​I said.

“I love you too,” she replied.

We recite Psalm 23. Mom joined in when we said, “Kindness and Mercy shall follow me as long as I live.” (She later remembered.)

The priest sang Mom’s favorite hymn, “Be Thou My Vision.”

We sang “Amazing Grace” and “Jesus Loves Me.”

I recite John 3:16 (“God so loved the world…”) and John 1:12 (“Everyone who accepts Him…”)

“I can’t speak very clearly,” Mom apologized through the mask.

“Yes, you can,” I countered. “You just said, ‘I can’t speak very clearly.’ ” She laughed. (Mom later remembered.)

We watched as Mom’s blood pressure stabilized and then started to rise. My nephew is here. Mom thanks him for coming. Her sister is here. She chatted briefly with her mother.

Jamie and Shirley’s friends are here. They joked that the last time he visited her in the hospital, he found her a bed by the window.

The mask is uncomfortable and cannot be adjusted. Workers replace masks with forks.

Mom sat up and talked freely. I’m kidding. She smiled, and the monitor showed her breathing deepened.

She wonders why everyone looks so sad (which she later remembered), and…can she have some breakfast?

After tea with toast and jam, Mum was taken upstairs to the cardiac ward. My husband, our daughter and our son came. Mom was happy to see them, but sorry for worrying them. Our other girl called and she had a great chat with her mom. Mom was delighted, but a little disappointed that my brother couldn’t Skype the Nicaraguan family.

She’ll never regain cognitive function…she won’t know them.

Later in the afternoon, she was moved to another ward. When we left for the night, Mom said, “I had a great time.”

Mom has more visitors and newspaper crosswords on Sunday.

On Monday, another cardiologist, Dr. A, is making his rounds. I asked him, “If a 90-year-old had a severe heart attack like Mommy did, would you say she would never regain cognitive function, just based on her age and the severity of the attack?”

He seemed surprised by the question. “Total loss of cognitive function? Did anyone tell you that?”

Yes, I answered without elaborating.

No, he replied, he wouldn’t have predicted that. In fact, mom will most likely be home for Christmas and should be able to continue living in the same situation.

In the afternoon, she and I enjoyed a Christmas carol concert at the hospital.

That night, she proofread her grandson’s introduction to her honors thesis. She found some minor errors and looked forward to reading the paper when she was done. Mom wondered if a picture of the guy my nephew was writing about would be helpful. She found one online last year but can’t remember the URL. I noticed the suggestion on my nephew’s paper.

Mum wrote Christmas checks to grandkids and great-grandchildren and asked Jamie to bring the crossword answers tomorrow.

she won’t know them

There was no apparent new damage to the heart from Mom’s second heart attack, a medical student told us Tuesday.

Mom was released from the hospital on Wednesday afternoon. She sends thank you cards to cardiac wards and emergency departments.

Poor poor first responders. The woman believed it was her health care card, even though her mother handed it to her in what was apparently a greeting card envelope. (Do you think they might not get many thank you cards in an emergency?)

My concerns about advance directives, at least as we write them, are as follows:

1. Physicians who favor early termination of the elderly (my term) may interpret terms like “in a coma,” “in a vegetative state,” and “no hero measures” in ways that neither we nor our loved ones can understand. want.

2. In a slightly different case, I had a friend who watched her father gasp for breath. Apparently, the staff interpreted the earlier verbal instructions not to use a feeding tube as “no intervention”; so they ignored my friend’s pleas to give him oxygen. She eventually called 911, and paramedics gave her father oxygen at the hospital. He died about a week later, apparently in relative comfort.

We’ll never know if this man was allowed to suffer as he apparently did (apparently there’s no evidence) because the staff truly believed that no feeding tube also meant no oxygen, or if they just thought he was a man with advanced Alzheimer’s The old man with Murphy’s disease, his time has come.

My own father died in the same palliative care facility. He prescribed “no hero measures” and was given a feeding tube and oxygen as well as pain medication. I believe he died in relative comfort. Maybe it depends on who was working that night, or whether the patient had Alzheimer’s, or who was with them at the time. Dad’s mind remained clear and he was able to communicate verbally and in writing until he fell into a final coma. Plus, his hyper-vigilant elderly nurse daughter-in-law and the rest of us are there for him.

I once spoke to a nurse who said she was refusing to give oxygen to a patient who was pointing at a mask because it had been instructed in advance, explicitly requested. She said she just held these people and tried to comfort them as they died.

It appears that even well-written advance directives can lead to unnecessary suffering and premature death.

The solution my brother and I are considering is simply a list of surrogates with full contact information so that a decision can be made at that time.

Regardless, we need to be very, very vigilant when our loved ones cannot speak for themselves.

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