By Norris Burkes
Jan 07 2018

Hospice chaplain Dale Swan has always been clear with his wife, Jill, about how he wants to die.

“If I get sick and can’t feed myself or make my own decisions, please don’t let them put in a breathing or feeding tube. Let me go peacefully.”

Jill, a CPA who is used to calculating the options, responded in the way many families do: “But I don’t want you to starve to death.”

Dale reassured his wife of 34 years that his hospice colleagues would be there for her and wouldn’t let him suffer.

Dale is a 58-year-old avid cyclist who showed no signs of impending problems until one evening this summer. He was watching TV from his recliner, eating a veggie burger and sipping a beer, when he was hit with troubling stomach pains.

He took some antacid and told his wife he was going to lie down. When Jill checked on him an hour later, she found his pain intensifying. She suggested a doctor, but Dale declined, instead making a restroom visit that brought only mild improvement.

An hour later, Jill heard Dale moaning with extreme pain. She insisted on taking him to the ER, but Dale countered by asking her to call 911.

When paramedics arrived they began assessing pain even as they were speculating it was a heart attack. Within a few minutes, EMTs placed him on a gurney and loaded him in their ambulance. Beside him, they hung an IV drip of Fentanyl, a strong opiate for pain control.

The ER doctor ordered blood tests, a CT scan and a sonogram. Dale was suffering from pancreatitis, but staff could find no cause. They ruled out stomach blockage, gallbladder problems and even alcohol abuse. Dale’s pain level was rising to alarming levels, with no apparent diagnosis.

Nurses admitted Dale to a room, ordered that he have no food for four days, and administered Dilaudid. However, once inside the room, the pain medication slowed his respiration to six breaths per minute. Dale was rapidly losing consciousness.

Hospital staff suspected an overdose and instructed Jill to keep her husband awake or they’d have to give him Narcan, a drug that reverses opioid effects.

“If that doesn’t work,” they grimly warned, “we’ll have to insert a breathing tube down his throat.”

Jill remembered Dale’s instructions and shocked the staff by saying, “Oh no, he doesn’t want that! He’s always said to let him die peacefully.”

Jill felt prepared. She and Dale had discussed many of the crucial questions involving the end of life and placed those answers into an advance directive, (often called a Living Will).

The Advance Healthcare Directive is a document that we should all have. It instructs doctors what we want done if we became incapacitated. Without the directive, doctors are obligated to do everything possible to save our life — even if “everything” means a painful delay of our inevitable death.

Fortunately, the medical staff knew this wasn’t a moment to give up on a healthful and strong patient. They helped Jill understand that Dale’s document didn’t apply to situations where a full recovery could be logically anticipated.

While Dale has fully recovered and returned to work, the happy couple is taking no more chances. Dale’s given Jill more detailed instructions. And Jill, ever the logical number cruncher, is reviewing their life insurance policies — just in case.

More information on state-specific advance directives is available at Email me at Voicemail 843-608-9715 Twitter @chaplain Read past columns at