Friday, March 27, 2015

End-of-Life Decisions Empower Us

I recently lost a dear friend way too soon. She was young at heart and vibrant, but she had suffered from multiple illnesses and the complications of chronic illness. Of course, as a nurse, she wasn't always compliant with the care prescribed, and being retired, finances often didn't allow for the best options. She always put everyone else first.

So when she was hit with a health crisis that kept building, we knew that she knew exactly what was going on. And soon she took charge and said "no more!" It was heartbreaking to learn that she was "giving up" when in reality she was taking charge! We knew how bad it was and we all had to honor her choice and support her in the last hours, while we hoped for a miracle! Of course that didn't happen, and she crossed over listening to her favorite playlist and was at last at peace. And it was on her terms.

End-of-Life Decisions
End-of-life decisions are difficult to make. Then when they need to be invoked it's not always so cut and dried. What really constitutes comfort measures and how far do you go with them?

When a patient is on hospice and knows he is dying, he often faces the dilemma would he want to be treated with antibiotics if he develops an infection such as a UTI or has respiratory symptoms after aspirating? Is it a comfort measure or does it prolong his life? Will death be hastened if the antibiotics are declined? There are no absolute answers. Sometimes it seems to hasten things, and other times patients pull out of it and go on. We can predict, but we have no guarantees.

NO CPR  Tattoos
I've shared with many nurses over my career that we should all have NO CPR tattooed on our chests or even our foreheads. It's one thing to have a cardiac or respiratory arrest and not be resuscitated, but Advance Directives and POLST forms ask the harder questions. Do you want antibiotics, do you want hospitalizations? And under what circumstances? Get specific.

A common answer or scenario I hear is, "well if I fell and broke my hip, I'd want to go to the hospital and have it fixed." But we know statistically that a major injury from a fall is tied closely with morbidity rates. Yet how many times do you see 98 year old patients having an ORIF?! I've even seen some patients have total hip replacements at that age, while on hospice to boot!

Advance Directives

It's about choice and even with Advance Directives, we have the right to revoke them and opt for another plan. They are guidelines to help us intellectually decide things our hearts may find gut-wrenching when the time comes. But they help our loved ones know what we would want if we can't make our own decisions. We need to be clear about what we want and help our loved ones know this is the course they need to take for us and not feel guilty or burdened.

I had had many conversations with my friend over the years and knew she was going to invoke this if she had the chance. And if she couldn't, her family would have to honor her decisions and make them for her. It just seemed too soon, but we knew her uphill battle was not going to be won either. Her quality of life would be poor at best if she did survive, and that was NOT what she would have wanted. Rest in Peace my friend and than you for having made the hard decisions. It was empowering to know that you had control of your destiny.

End-of-life decisions give us that power. Think about yours, it's never too soon to make a plan.

This post was written as part of the Nurse Blog Carnival If you are interested in participating find out more details and sign up here.


photo: http://all-free-download.com/free-photos/papaver_rhoeas_poppy_field_221681.html

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