Opinion by Gerald Trumbule
I know this isn't something most people want to think about, but I have to admit that as I grow old, I find it coming up more often. Especially as my friends die off.
Twice in the last few years I've had friends who I assisted in completing the "Five Wishes" questionnaire which sought to provide a living will, answering end-of-life questions for themselves. In both cases their stated wishes were not followed.
In one case, I got a personal call from the head surgeon, who honestly related to me what had happened in the operating room.
My friend (in his mid-50s) had gone in for open-heart surgery with a well-known surgeon. He had had a heart-attack three days earlier and knew that his heart was in bad shape and was looking forward to the possibility of repairs. I was named as the person to look after his affairs in the Five Wishes document. He had stated that he did not want "extraordinary measures" taken.
During open-heart surgery your heart is taken off-line and your blood is circulated by a pump. "When we tried to start his heart back up, it wouldn't start" the surgeon explained. "And that's when the surgical team split on what to do next. There were six of us involved, and three wanted to stop. The other three wanted to thread a balloon up to his heart which would be externally driven to rhythmically inflate and thereby drive his heart (extraordinary measure). They won, and this device was threaded in place, but then we discovered that he was unexpectedly bleeding out. We couldn't find the source at first but soon learned that we had nicked the blood vessel through which we had threaded the balloon in a nearly inaccessible location behind his stomach. At that point we were 7 hours into the surgery and we stopped."
Clearly my friend would have died with or without the "extraordinary measure". But the point here is that his wishes were ignored.
The other friend had an inoperable brain tumor. She was adamant about not wanting radiation or chemo-therapy. As time went by, her resolve was worn down and she acquiesced. To me it seemed that while there was almost no hope that the procedures would have any effect, they wanted to run her through the very expensive and debilitating treatment anyway. Drugged and diminished, she had given in.
Well, the good news is that there is now a more powerful version of the Five Wishes that is available. It is called the Colorado Medical Orders for Scope of Treatment (MOST) and you can get it here. The difference is that your doctor has to sign this one. But the problem is you still have to decide.
I had always chosen "yes" on most of the choices. Yes to CPR, yes to intubation, yes to mechanical ventilation, yes to IV whatever. Until I read this article.
Turns out that doctors choose none of this stuff. Not even CPR, which hardly every works in real life, unlike the movies. Doctors just want to die peacefully, and not in hospitals.
As it happened. I was in my doctors office a few days later and told him about the article and asked if he had a living will with directives. "Yes." he said. "May I ask how you filled it out?" He had said no to CPR and everything else. Why? "Because I don't want to end up in a nursing home."
So, having now spent over 27,000 days on earth, I've arrived at the conclusion that it would be best for me to depart without medical heroics. I haven't filed the form yet.
What's your choice?
Thursday, January 23, 2014
Opinion by Gerald Trumbule