Cute Pictures Of Puppies To Cheer Up 2 Year Olds Advance Directive Warning

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Advance Directive Warning

Approx. 1:30 Saturday morning, December 18, 2010

“I think I need help!”

Mom is standing outside my bedroom door, gasping for breath and writhing in pain. She says she waited an hour before waking me up.

(Backstory: When I arrived last night, Mom told me she sometimes feels “uncomfortable” at night. Knowing she had a major 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 tell me to make sure pets are secured and the door is open. I say, “I can’t leave my mother’s side.”

After what seems like 10 minutes, I call 911 again. “They’re at the door,” says the dispatcher.

There are two paramedics and four firefighters, including the captain of the Fire Department. Some give first aid, others ask about Mom’s Advance Directive. I find it and point out that it doesn’t say don’t treat her.

We arrive at the hospital, a renowned treatment, research and teaching facility. Dr. C. (cardiologist) and Dr. N., as well as many other staff, take care of Mom.

They are very concerned about her Advance Directive. Again, I point out that it does not say that she should not be treated unless she is in a coma, and she is not.

“She is very, very sick,” they say. “What would she want?”

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

I show one of the doctors the part of her Advance Directive that says she does not want to be kept if in a coma or vegetative state with no hope of recovery. “She’s not in a coma,” I say. He looks meaningfully at her motionless form, bound to machines.

If I had my wits about me, maybe I could say something like, “If they brought in a 20-year-old football player who had just had a major heart attack and you administered morphine, how sensitive do you think he would be? And are you so quick to dismiss him?” But I can’t form those thoughts, let alone express them. I just feel that there is something wrong with the doctor’s reasoning.

They talk about the possibility of surgery to save her life.

I’m calling my brother, Jamie, and his wife, Shelly (a geriatric nurse). Shelly thinks mom will die without the surgery. That’s what the doctors do. Jamie and I give permission.

Jamie and Shelly arrive at the hospital.

The doctors decide against surgery. Too risky. We agree.

Dr. N. wants to discuss the options right there, in front of Mom. But I’ve read that comatose—or apparently comatose—patients sometimes give up and die when they hear a negative prognosis.

I say “Not in front of her”, and we go to the Quiet Room. Dr. C. explains again that surgery is not an option. We agree.

Dr. N. wants to stop treatment (IV medications). He tells us about an experience in medical school, when the professor made it difficult for the students to breathe, and recounts his horror. He believes she is suffering and is certain she will “never regain cognitive function.”

I want her to see her grandchildren and great-grandchildren, some on the way and some here in town. “She won’t know them,” says Dr. N.

“Are you sure?”

He is certain.

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

Jamie and I give permission to stop medical treatment because Mom is likely to suffer intensely and will never regain cognitive function. Just before giving final permission, I look to Heaven for wisdom and believe the answer I hear is yes.

They keep the same dose of blood thinners but lower the dose of medicine that raises 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 drops. We gather around to sing and pray. Through her mask, Mom says, “I have so much to be thankful for.”

“Thank you for being here with me,” she says to each of us—Jamie, Shelly, and me.

“I love you mom” I say.

“I love you too,” she replies.

We recite the 23rd Psalm. When we get to “Surely goodness and mercy will follow me all my life,” mom joins in. (She remembers this later.)

The chaplain sings “Be Thou My Vision,” Mom’s favorite hymn.

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

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

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

“Yes, you can,” I counter. “You just said, ‘I can’t speak very clearly.’ “She laughs. (Mom remembers this later.)

We watch as Mom’s blood pressure stabilizes, then begins to rise. My nephew is coming. Mom thanks him for coming. Her sister is coming. She and mom chat briefly.

Jamie and Shelly’s friend come over. They joke about the last time he came to see her in the hospital and got her a bed by the window.

The mask is uncomfortable and no amount of adjustment can make it fit. Staff replace the mask with pins.

Mom sits up and chats freely. I’m kidding. She laughs, and the monitor shows deepening breaths.

She wonders why everyone looks so sad (she remembers this later), and… could she have breakfast?

After tea with toast and jam, mum is moved up to cardiac unit. My husband, our daughter and our son are arriving. Mom is happy to see them, but sorry she made them worry. Another one of our girls is on the phone and she and Mom have a nice chat. Mom is happy, but just a little disappointed that my brother can’t get the family’s Nicaraguan Skype connection.

She will never regain cognitive function…she will not know them.

Later in the afternoon, she was transferred to another ward. When we leave for the night, mom says, “I had a wonderful time.”

On Sunday Mum enjoys more visitors and a newspaper crossword puzzle.

On Monday Dr. A, another cardiologist, makes rounds. I ask him, “If a 90-year-old person had a heart attack as severe as Mom’s, would you say she would never regain cognitive function, based only on her age and the severity of the attack?”

He seems surprised at the question. “Total loss of cognitive function? Did someone tell you that?”

Yes, I answer without elaborating.

No, he replies, he wouldn’t have predicted that. In fact, Mom might well be home for Christmas, and should be able to continue living in the same situation.

She and I enjoy a Christmas concert at the hospital in the afternoon.

That evening, she finishes proofreading her grandson’s introduction to his Honors thesis. She found some minor errors and looks forward to reading the paper when it is finished. Mom wonders if a picture of the man my nephew is writing about might be helpful. She found one on the internet last year, but doesn’t remember the website. I note the suggestion on my nephew’s paper.

Mom writes Christmas checks for the grandchildren and great-grandchildren, and asks Jamie to bring the solution to the crossword puzzle tomorrow.

she will not know them

On Tuesday a medical student informs us that there was no significant new damage to the heart from this, Mom’s second heart attack.

Mom is discharged on Wednesday afternoon. She delivers thank you cards to the physical department and the Emergency Department.

Pity the poor Emergency clerk. Even though Mom hands her the card in what is obviously a greeting card envelope, the woman thinks it’s her Health Care card. (Do you think maybe they don’t get a lot of Emergency thank you cards?)

My concerns about the Advance Directive, at least as we wrote it, are as follows:

1. A doctor who favors premature termination of the elderly (my term) can interpret terms such as “in a coma”, “in a vegetative state” and “no heroic measures” in such a way that neither we nor our loved ones. would

2. In a slightly different case, I have a friend who watched helplessly as her father gasped for breath. Apparently staff interpreted an earlier verbal instruction not to use a feeding tube to mean “no intervention”; thus they ignored my friend’s pleas to give him oxygen. She finally called 911 and paramedics administered oxygen to her father at the hospital. He passed away a week later, apparently in relative comfort.

We’ll never know if this man was allowed to suffer the way he apparently did (there’s no proof, obviously) because staff really believed that no feeding tube also meant no oxygen, or if they just felt he was an old man with advanced Alzheimer’s whose time was up. had come

My own father passed away in the same palliative care home. He specified “no heroic measures” and was given both a feeding tube and oxygen as well as painkillers. I believe he passed away in relative physical comfort. It may depend on who is working that night, or whether the patient has Alzheimer’s, or who is with them at the time. Dad’s mind remained clear and he was able to communicate orally and in writing until he slipped into the final coma. In addition, his very lively geriatric nurse daughter-in-law was at his side, along with the rest of us.

I once spoke to a nurse who said she refused oxygen to patients who showed the mask, clearly asking for it, because of prior instructions. She said she just held these people and tried to comfort them as they died.

It appears that even a carefully drafted Advance Directive can result in unnecessary suffering and premature death.

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

In any case, we must be very, very vigilant when our loved ones cannot speak for themselves.

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