People have asked me some funny questions, but I was taken aback recently when a fellow church parishioner asked me about my work as a VA hospital chaplain.
“Do people die in your hospital?” he asked.
“Well, yes,” I said, “even though we’d prefer they’d not.” He asked because, as we sat in church, he couldn’t imagine anyone dying.
My churchgoing friend shares a problem most of us have – we can’t imagine the possibility of our own death.
Several years back, I was working in another hospital when a 60-year-old man arrived by ambulance. He had been ignoring chest pains the entire day until he finally collapsed and a neighbor called 911.
Our patient arrived in our ICU breathing on his own, but he had waited too long to seek help. He was in trouble. Decisions needed to be made and his 35-year-old daughter arrived in time to make them.
“Does he have an Advanced Directive?” asked his doctor.
No, he did not.
Our patient, like perhaps many people, had failed to ask himself the right questions. Those questions are contained in the Advance Directive (sometimes called a Living Will).
An Advance Healthcare Directive is the document that “directs” the doctors to follow the wishes of the patients who are unable to speak for themselves. Without an advance directive, doctors are obligated to do “everything” possible – even if that means a painful delay of your death.
With his failing breath he begged his doctor to do “everything possible.”
Unfortunately, if the doctor had done “everything” he would have placed our patient on the indefinite support of a respirator. Respirators work well when doctors are expecting recovery, but since the entire right side of his heart was dead, the respirator would have only suspended him between life and death.
The doctor told the daughter that her dad was unfixable and that if the staff attempted anything heroic, her dad would spend the rest of his life on a machine.
The woman, who was an accountant, quickly did the math. Realizing that quality of life was more important than quantity of days, she stepped into his room and gave her dad one of the bravest speeches I’d ever heard.
In my recollection, the conversation went something like this:
“Dad, you know I love you, right? I’ve always told you the truth. Right?”
The man nodded.
“Dad, your heart’s broken.”
“I know,” he huffed. “Let’s fix it and go home.”
“Dad, listen to me,” she pleaded while she stroked his forehead. “They can’t fix this and if they try, you’ll end up on a respirator for the rest of your life. I know you don’t want that, so you need to tell the doctor.”
The aging father argued. “Yes. They have to fix it. Who will take care of Mother?”
“No, dad. They can’t fix it. No one can. I’ll take care of Mother. I promise.”
I knew the wind had shifted in this argument when the man asked, “Will it hurt?”
“We’re going to make you comfortable, sir,” was the doctor’s softened reply.
Then I saw the woman lower her head onto her father’s chest and look into his eyes. They exchanged words I couldn’t hear, but a few minutes later, I heard the man say, “OK. Let things happen as they happen.”
With that decision, the nurses administered “comfort care” and made sure that the man’s final question about pain was answered.
And latter that evening, he decided to let go and the daughter did too.
For more information on Advanced Directives, and to download your state’s Advance Directives go to www.caringinfo.org