The exact right questions

[susandennis]

I just got an email from Trey, my sister in law. She asked if Mom had a Living Will and/or code instructions. The Do Not Recessitate instructions are in a large pill bottle in the door of the freezer. The management of the 'home' sent around the document and the pill bottles and the instructions about where to keep it. I remember thinking at the time how brilliant that was.

I don't think she has a Living Will. I will have to check when I get home. I know I have medical power of attorney or as Mom called it Pull The Plug Powers.

But, mainly, I was so glad that 1) Trey is thinking and planning instead of just living in it-will-all-be-all-right-land and 2) that she was comfortable enough to ask me.

Comments

[annenahaymus.livejournal.com]

Yep, sounds like your sister-in-law is handling this in a very practical way. That must be of some comfort. I'm keeping you guys in my thoughts.

[susandennis]

You are so right. It is enormously comforting to know she's not stressing over stuff she can't do anything about and planning for likely contingencies instead of waiting until they happen. It sure takes a load off my shoulders.

[joyofmacs.livejournal.com]

It is good that you folks are thinking ahead and know where things such as a living will are located.

When my mother-in-law died, she died being recessitated. She HAD a Do Not Recessitate Order and a Living Will and info on a medical bracelet but when the parametics came that fateful morning, she had taken the braclet off and they did not of the bracelet or any of this. I guess my father-in-law, being elderly panicked and said nothing to the paramedics.

So we live with the horror of knowing her last moments on earth must of been horribly painful AND said painful efforts were futile from the get-go.

My father-in-law was sharp as a tack but stubborn. Had no living will or any instructions. He too suffered the last two days as no one should.

I am glad that all the ducks are in a row concerning whatever comes next. No one should ever have to suffer the way they did at the end.

[geordie.livejournal.com]

Is she really that close to the end? My grandmother has been on her last legs for 20 years, well at least if you believe her. Here's hoping for a return to status quo.

[keelamonster.livejournal.com]

As a medical professional, I'm going to say a few words here: Thank GOD you guys are talking about this stuff and when your mom appears to be doing well. It's so hard when the first time families talk about this is when the doctor at the hospital asks, "does your mother have any thoughts about CPR?"

If you have a legal medical power of attorney, your mom doesn't need a living will. The living will is not a very useful legal or medical document other than it says, "I don't want a feeding tube or CPR", etc. The POA is a much better document. Just make sure that your mom's doctor and hospital have a copy on her chart for whenever she needs it.

The Do Not Resuscitate order is a little different. It's an actual doctor's order on a patient's chart. In NC, you have to have one that's all filled out by the attending that either states that the patient cannot make decisions and his/her POA decided this, the patient can make decisions and wants no CPR or that 2 attending physicians agree and attest to the futile nature of resuscitative efforts. This order is the one that tells the paramedics it's okay not to do CPR when they arrive at a scene. So you have to make sure that there's a copy on your mom's clinic chart, her hospital chart and an extra one for her at home, although it varies by state law.

It never hurts for your mom to write out a statement of her desires:
Does she want to be intubated (tube down her throat to breathe for her in CPR)? many people say "do CPR but don't put me on a breathing machine or intubate me." As much as I understand why they say it, it means they have a basic lack of understanding about CPR. If you can't breathe, what good is having your heart beat? So we tell people if they don't want to be intubated, we respect that, but we will also not do the rest of the code or CPR because it's a waste of time. Most people either decide they want CPR or they don't at that point.

Does she want CPR itself? SOme people got into the habit when I was in residency of making people "medical code only." Which meant that they didn't want to be intubated or shocked or have compressions, they just wanted us to give them medicines. I lobbied very hard in my program to stop doing that because a) the patient's family still had to pay the bill for the code, even though we didn't do CPR and 2) there is absolutely no point in giving someone an IV medication if their heart is not beating to circulate it. That's the point of the compressions: to move blood around and get the medicine where it needs to be. Most people, when the basic concept of CPR is explained, understand this and then decide Yes or No about it.

Does she want a feeding tube if she can't feed herself (ie, if she has a stroke and can't communicate or swallow anymore)? this is the one most people don't think about when they're making these decisions and it's the way that we keep a LOT of old people alive for years that probably wouldn't have wanted

Anyway, I didn't mean to ramble, but this is a really tricky subject and one that's dear to my heart. I can't tell you the number of families that have let their loved ones suffer just because they weren't ready to let go of someone. It breaks my heart every single time.

[susandennis]

Ohmygod - you are wonderful!!! I cannot believe you went to all this trouble to explain everything so clearly! And I'm not sure I can thank you enough. My Mom and I both thank you thank you thank you! I've now read it three times to make sure I've got it all.

Her desire is to be let go period. No feeding tube, no CPR, no tubes, no nuthin'. But, only I really know that. Your suggestion to have her write it all down specifically and clearly is a great idea. And she will think so, too.

And that is also excellent info about the Living Will/POA. Thank you! And, you reminded me that I need to let Polly know, too. Maybe even give her a copy of what Mom writes.

Thank you, thank you!

[keelamonster.livejournal.com]

Oh, I'm just glad to help!

[susandennis]

And, guess what?! I got home and checked the Mom's Legal Docs file and found:

Declaration of Desire
Will
Regular POA
Health Care POA

And, thanks to how much smarter you made me, I checked thoroughly and found that the Declaration of Desire spells out specifically (with Mom's initials at each point)

No tubes - feeding or otherwise
And nothing administered to prolong life only to provide 'comfort care'
And giving me authorization to enforce on her behalf...

AND I know exactly where in Mom's house these docs are. We are so set. I feel so relieved. And proud of us.

[rsc.livejournal.com]

Between Trey and Polly, it sounds like your mom is in excellent hands. I'm hoping for the best for all of you.