Death panels

 

Judy and Rob 2012

  I have been worried ever since I read Atul Gawande's Being Mortal: Medicine and What Matters in the End and Katy Butler's Knocking on Heaven's Door: the Path to a Better Way of Death.  What if Judy has a breathing crisis and I call 911 and the EMTs or the ER docs do something to her that will increase her suffering without any benefit? Something that would result in a permanent situation that she definitely does not want, such as being put on a ventilator?  Nephew Rob, the Emergency

Medical Technician leader, says that his guys are required to "do everything" unless they can find a POLST do not resuscitate order.  What is "everything?'" And how am I supposed to know if it will do any good?  How does one procedure  lead to another?  How will I know what to say yes or no to, especially when I am frightened and all I want is for Judy to breathe better? Judy says, "If a procedure can reverse a situation, do it.  If the situation cannot be reversed, don't do it."  Not nearly specific enough to guide me through my ignorance.
  Judy meets with a new pulmonology fellow every other August. When this year's  fellow, Dr. Sakata, asked, "Do you mind if I type while we're talking?"  I thought, "Oh, no, he's not going to take his head out of his computer." But he was wonderfully direct. At the end of the visit he scooted his stool closer to Judy and looked her in the eye and said that now we needed to talk about end of life issues.  "Do you have a POLST (Physician Orders for Life Sustaining Treatment)?" Here's the thing about intubation and ventilators."  Judy talked about her wishes. I expressed my worries about my lack of knowledge.
Dr Sakada told me that if I see mask go over Judy's face, that's OK, but if I see a long tube ready to go down her throat, that's when I should say no.  That is the level of detail and simplicity that I need.  
   Les and Betsy have been reading the same books.  Les, ever prepared and thorough, worked and worried over the wording of advanced directives, supplemental letters to the directives, and health

Les and Betsy

authorization releases.  These are legal documents stating a patient's wishes in great detail and authorizing representatives to make health care decisions for her.  We spent a working morning with Betsy and Les drinking coffee, eating fruit and cinnamon rolls, and going over the documents word for word.

Ukulele buddies with Maddie

     Of course, all this fussing helps me avoid my deeper fears.
     Meanwhile, life goes on.  Judy and her ukulele buddies sang "Happy Trails" to their favorite  waitress, who will be leaving the Painted Lady.  Maddie is  beginning community college, the first step in her long-held dream of becoming a registered nurse.