Monthly Archives: November 2013

Fog Light Blog Light

DNR, CPR, IVF, ADL, PRN, POA, AD/LW, PO, HS, PCP, MS04, IADL, PT, OT, RN, NP, NPO,LPN, CNA, NA, MD, ANH, LSW, TPA, MI, CVA, TBI, PVS, MHB, ARDS, ESRD, COPD, BMP, GTT, CF, ARF, ETOH.

Imagine, just for an instant, that you are being timed and are expected to immediately recite the purpose, meaning, and logic behind these initials. Above is a very small assembly of abbreviations comprised from the thousands of potential references we may encounter during an emergency or critical medical event – an event that may require us to act on behalf of someone we love deeply or for whom we are responsible.

A simpler life. That’s all I ask, I saw it on the intranet or internet, or maybe found it on an iPod, iPad, iPhone, now I need an eye doctor, lawyer, shrink … can anyone tell me what any of this means? We hear what we want to hear, and often miss the details of an entire conversation because we are focused on the one phrase, word, or number which triggers a SNAP-TO-ATTENTION(!) response of every sense in our body. That one moment is different for each of us … where we begin to wonder/wander in our heads. How long do they have? Are they ever going to be able to walk, talk, eat, breathe, see, hear, live again? What does “managed expectations” mean? What is an “optimal outcome”? What is a “best case scenario”? How do you do “symptomatic treatment”? What does “viable” even mean?

Despite the magnitude of information we are granted easier and faster access to, the emotions remain mutual for us all.

Fear

Love

Grief

Joy

Sadness

Empathy

Understanding

Doubt

Hope

Anger

It is not unusual to see, feel, hear, and experience all of these in a few moments.

DEATH = the glass is half empty. LIFE = the glass is half full. No matter where we place out trust. Faith is the strength that stays as constant as the magnetic forces at work in the universe to help create and hold us in place.

Faith, and the freedom to express that trust, varies as widely as each smile and as deeply as every dream. Welcome this feeling each day with warmth of heart and reach into the lives of each other with the renewed gift of another day. Share your thoughts, imagine the beauty, and sleep in the satisfaction of having given the light of clarity to those you love. Knowing this (your wishes) will provide the power to generate the force that lifts the fog of confusion and stress surrounding the decisions of what to do when faced with the task of deciphering the multitude of medical and legal abbreviations, terminology, and codes.

Caring Choices stands ashore of your voyage with beaconed guidance to assist when life will finally welcome you home.

Beyond a Vague Checklist

When I went to my doctor’s office for my annual medical appointment this year, I was met with a couple of topics that coincide with hitting the “Big 5-0”. In addition to the regular taking of vitals and checking medications, it was suggested that I should do a few other things: get a flu shot (done), consider a pneumonia shot (not interested), and, oh, yes, schedule a colonoscopy (yuk). Of course, these are some of the preventative measures that we take to avoid getting knocked down by a virus or to detect one form of cancer in a treatable stage. I confess – the idea of a colonoscopy produces a great deal of anxiety in me. I am no doubt worrying about something that will probably not happen but the anxiety is there nonetheless. And don’t even get me started about the stories well-meaning friends share about the prep!

One area that was presented in a hurried manner was the notion of an advance directive. I sensed this wasn’t exactly a comfortable topic given the very general statement of something like … “Now that you’re 50, you should start thinking about an advance directive.” Now, I did share that I’m pretty well versed in advance directives and that I have all my “paperwork” in order already. I could sense quiet relief in not having to have a “death talk” as I happily took the form handed to me. And there, the conversation ended.

The form I received is pretty basic … and rather vague. The first paragraph notes that I am of sound mind and am voluntarily making this “declaration … if I become dependent”. What does that mean? Dependent? In what way? On whom? On what? The next paragraph directs my attending physician to “withhold or withdraw life-sustaining treatment that serves only to prolong the process of my dying if I should be in an end-stage medical condition or in a state of permanent unconsciousness.” Well, that certainly clears things up.

Then comes the checklist portion of the document, where one is supposed to actually check “I want” or “I do not want” in the boxes next to the inventory of items:

(Please circle your response)
Cardiopulmonary Resuscitation (CPR) The use of drugs and/or electric shock to start the heart beating and artificial breathing	I want	I don’t want
Mechanical Respiration Breathing by Machine	I want	I don’t want
Tube Feeding Artificial, invasive form of food given through a tube in the veins, nose or stomach	I want	I don’t want
Artificial Hydration Artificial, invasive form of liquids given through a tube in the veins, nose or stomach	I want	I don’t want
Blood or Blood Products The use of whole blood or parts of the blood to replace blood lost	I want	I don’t want
Surgery Use of any form of surgery to remove or repair any part of the body	I want	I don’t want
Invasive Diagnostic Tests Tests that help reach a diagnosis by entering the body in some way, i.e., a tube inserted to look at the stomach, etc.	I want	I don’t want
Kidney Dialysis Machine used to cleanse the blood of toxic waste because the kidneys are unable to do so on their own	I want	I don’t want
Antibiotics Medicine given to treat or prevent an infection	I want	I don’t want
Other:	I want	I don’t want

There is no statistical information that tells me how any of these things might be considered life-sustaining in my “dependent” condition. There is nothing that explains risks and benefits of these items should I decide I want (or do not want) them. This document does not provide specifics that will be helpful to my loved ones and my healthcare providers in making real-time, middle-of-a-medical-crisis decisions that will follow my wishes and provide me a peaceful death.

This is why personal conversations with those we love are so important. The collective understanding that comes from discussions with those we love will carry more weight with healthcare providers than any piece of paper. It will be important for spouses/partners, children, siblings, and closest friends to hear directly from us about the kinds of conditions for which we want treatment or not, and when we want them to let us go.

The approaching holiday gatherings with family can provide each of us an opportunity to begin these essential conversations so that when the time comes, those we love will all know what to do and when to do it. And we will know that they will be there to support each other and love each other after we are gone. There is no greater gift to give this holiday season.

Let Caring Choices help you have your family conversation. The first step is the most difficult to take, but you need not take it alone.

Reunions…Funerals…Birthdays…Holidays…Graduations…Anniversaries…Sports Championships…Etc.

Many events occur on a yearly basis. Having attended several of these events in the past year, a pattern of recurring thoughts has developed for me. The majority of us begin with planning far in advance. Invitations are picked and mailed, surprises decided on, gifts purchased, entertainment booked, speculations and statistics compiled and studied with bets placed. In some instances, preparations for the following year begin before the current event has even taken place. Holiday decorations appear months prior to the actual season beginning.

Of all the above times when friends and families gather, funerals are the only ones which occur with irregular frequency. For most of us, there is no planning or preparation. For many of us there is a sudden, often fearful, moment when we realize how little we understand the process. We have no idea where to even begin with deciding what to do with the avalanche of responsibilities now thrust into our lives which require immediate attention. Some are fortunate to have family and friends who have recently experienced something similar and offer resources and comfort. Others are not so lucky and find the burden of these tasks rests entirely on them. Why is that? For me, it is a multitude of reasons why in my late 50s, I have just now developed and finalized my Will. I have filled out a Five Wish’s form, and discussed the distribution of assets with my wife and family. Mostly because I never thought about it when I had spare time, I was busy enjoying my time off work. I was not looking at the problems I saw over and over again in the lives of those around me as “my” concern. Despite the efforts I made professionally and personally to help as much as I could, I still had not made any preparation in my own life for my family.

Today, I have a new hope. I hope that through continued discussion and planning people will come together for the intent purpose of sharing their wishes, discussing their options, listening to the experiences, and developing the plans for recognition and acceptance of the life (lives) that will continue on after we are gone.

Not to deny the process of grief, or to ignore the pain of loss, nor to minimize the hope of comfort, but to embellish the life we have now and lessen the despair and burden of those we leave behind as we make the next step along our journey. Together in conversations, we can celebrate our love, we can laugh, we can cry, we can wonder, and we can hope. We can know in our hearts we have done all we can do to now, to let others continue tomorrow.

Caring Choices welcomes the opportunity to assist in these courageous conversations of honor, hope, and love of those who share the desire to prepare ourselves and our loved ones.

Life Support

“to live in this world

you must be able
to do three things
to love what is mortal;
to hold it

against your bones knowing
your own life depends on it;
and, when the time comes to let it go,
to let it go”

Those words are from a poem by Mary Oliver, a Pulitzer Prize-winning American poet. Her words have really come alive for me as I work with and counsel hospice patients and their loved ones.

Most of my hospice patients and their families have allowed me to witness the great strength of human connection. The lengths that some will go to in order to provide vital support to someone they love and care about are boundless. For hospice patients, “life support” takes on new meaning as well. No more does life support refer to CPR, ventilators or feeding tubes. Instead, “life support” becomes much more intimate and enduring.

I have watched an elderly woman tenderly holding the hand of her life’s love, all the while bearing a smile so as not to upset her husband. I have heard the calming voice of a daughter whispering “I love you” into her dying mother’s ear. I have met a retired preacher and his wife who never had children of their own, yet their home is always filled with the love of their many nieces and nephews and parishioners who take turns “helping out” with whatever may need to be done. Out-of-state sons and daughters temporarily abandon their busy lives and return “home” to provide loving care for a dying parent. The love that flows between the dying and those who love them is never-ending and it is humbling to witness these bonds. One of my favorite lines from Tuesdays with Morrie was something like: “Death ends a life, it doesn’t end a relationship.”

There will always be death. We cannot live life and “love what is mortal” without suffering through the deaths of people we love. What we can do is exactly what Mary Oliver tells us to do in her poem above. Love as if life depends on it – then, when it’s time, we need to be strong enough in our having loved to let it go. It’s the emotional “pulling of the plug” that makes death so difficult to bear. But just as my patients’ families and friends surround them in their final months-weeks-days-hours, so to (hopefully) will family and friends provide life support to us as we move through our bereavement.

Caring Choices can help you and your loved ones strengthen your life support so that you can face letting go. Call us for more information today.