Last year, a psychologist, a social worker and a doctor accompanied me into the hospital room of an 84-year-old Korean War veteran who I remember as Ken. The doctor, a consulting physician, introduced us as the palliative care team for the VA Hospital.
Ken’s wife of 51 years stood to shake our hands with a self-assured grip. The woman, likely in her 70s, had the well-heeled look of a senior model. Ken, the victim of multiple strokes, did little to greet us, preferring instead the revolving wheel of a TV game show.
With introductions made, we pushed our chairs into a semicircle around Ken’s bed. Our psychologist, a ponytailed man pushing 60, spoke first. Had her husband been able to dress, feed and bathe himself? Did she think he had much understanding of what was going on with his body?
“No” to all those questions.
The doctor then assumed control of the meeting by picking up her stethoscope. She was an athletic woman who’d had some luck cheating her 50s with youthful blue eyes and a pixie cut. She bent over Ken, searching his expression for understanding, but she saw little to indicate that he was aware of his surroundings.
“He really needs a feeding tube,” the doctor concluded.
“Then let’s do that,” the wife said.
Actually, there were few options left for the old farmer. He’d had multiple hospitalizations and suffered several recent bouts of pneumonia. Each illness was followed by weeks in a rehabilitation facility in the San Francisco Bay area.
With great sensitivity, the doctor told the woman that even with the feeding tube, Ken would likely aspirate his saliva. In addition, he’d have to be restrained or heavily sedated because stroke-induced confusion would cause Ken to pull out the tube.
“Is this the way your husband wanted to live his later years?” the psychologist asked.
“No,” she said. “I suppose it really isn’t.”
“Sounds like he values the quality of his life,” I reflected.
She nodded. “He knows that heaven awaits.”
The hour-long meeting finished when Ken’s wife agreed to let us implement “comfort care measures.”
Comfort care means that every person taking care of Ken would adopt a new goal — one designed not to make Ken get better, but to make him feel better. Our goal shifted to helping him live as well as possible for as long as possible. With the help of social work, psychology and chaplaincy, we would now care for Ken’s whole person.
The real reason behind this difficult meeting was that Ken, like many people, had failed to discuss crucial questions with his loved ones prior to arriving on his deathbed.
Those questions are contained in the advance directive, (sometimes called a living will). An advance directive is the document that directs the doctors to follow the wishes of patients who are unable to speak for themselves.
If you don’t have a written directive, or you haven’t appointed someone who can confidently speak for you, then doctors will be obligated to do everything possible — even if “everything” means a painful delay of your death.
Ken was well loved by family and fellow vets, but the truth is that a well-written advance directive could have eased the burden on his family and ensured that he’d have spent his final days with the dignity of his choosing.
If you don’t have an advance directive, I urge you to get started today. More information on advance directives, and state-specific advance directive documents to download, are available at www.caringinfo.org.