let's talk about death, baby
by melanie sheckels
Our unwillingness to talk about death and dying often leads to poorly informed, and emotionally driven decisions about the health care we want to receive when we are critically ill. Misguided feelings of "not wanting to give up" on your loved one can result in nearly tortuous "lifesaving" measures. Talking about death doesn't make it come quicker. It doesn't mean you love that person less.
An advanced directive is a legal document that states your wishes in the event that you should stop breathing or your heart should stop. A healthcare power of attorney will legally appoint someone to implement those wishes for you if you are medically unable to make decisions for yourself. Your healthcare power of attorney should be someone you trust to know your intentions and speak on your behalf. I recommend having a notarized and witnessed copy on file wherever you go for healthcare. There are cheap, legal services online that will execute legal documents for you. You can also complete these forms at the hospital or at your doctor’s office.
What are the different resuscitation interventions? Can I pick and choose? What do they mean in terms of outcome or life quality? How do we have conversation about these things without sounding morbid? Someday you will likely find yourself in the position of answering questions that will irrevocably impact the life quality of yourself or a loved one. You will surely be stressed and exhausted. Your emotions will be running high. You will possibly be intense pain. In short, you won’t be well suited for major decision making. Do you have a Do Not Resuscitate order? If you were to stop breathing or your heart was to stop, do you want to receive CPR or to be intubated? When asked these questions upon admission to the hospital, most people respond instinctually. Of course, they want healthcare providers to do everything possible to keep them or their loved ones alive. Unfortunately, these decisions often have to be made very quickly to be effective. If someone is in a critical state, minutes spent going into detail about the risks vs. benefits of these interventions could make the point moot. This is why it is crucial for you to make an informed decision when you have the time to fully consider your choices and then make them legally binding.
CPR, as you probably know, is a series of deep, fast, and rhythmic chest compressions with intermittent breaths to simulate the circulation and oxygenation of the blood. If successfully resuscitated, a relatively healthy person should recover from this completely. CPR is generally unsuccessful at reversing cardiac arrest, but even when it is performed well and timely it can change your life forever. A common side effect of “high quality” CPR is cracked ribs and sternum. This is very painful and can cause significant damage to the organs in your chest, like a punctured lung. If intubation is necessary, then you would also likely be chemically and/or physically restrained. All of these increase the need for monitoring, which means more needles, more alarms, more invasive devices: a nose tube for feeding, a urinary catheter, a rectal tube, arterial catheter, not to mention the IV’s. All of those things increase your length of hospital stay, increase your risk for infection, and increase your risk for pressure sores. This experience borders on tortuous.
If you make it through the weeks to months of antibiotics and careful titrations of heart medicines, you will likely need intensive physical therapy to counteract the deconditioning of all your muscles. The end result is that very sick people who receive CPR generally go home with diminished physical and cognitive function. Another thing to consider is that this question isn’t as black and white as it seems. You can refuse CPR and still receive all manner of life saving medical interventions, medicines that break down in your system relatively quickly with easily reversible side effects leaving little to no long term impact on life quality.
In my work as a nurse, I care for people who have complex conditions that affect multiple body systems rendering them very ill. I also care for the people who love them. A hospital stay is a traumatic, life jarring event. It’s a thoroughly stressful experience for all involved in which you are poked, prodded and awakened all hours of the night by loud alarms and staff. It is also a scary reminder that our bodies eventually wear out. Talking with each other and preparing your advanced directives ahead of time will take a little bit of pressure off you and your family.
This conversation may not be an easy one; it may bring up unexpected emotions. If it is upsetting to think about, then you might want to ask yourself or your loved one if they have some unfinished business. Do you have regrets when you think about your life? What have you always meant to do but never got around to? What are you most proud of? What are your favorite memories? What makes it all worthwhile and when is it time to let go? This conversation is as much about living as it is about dying.