A Strange Way To Celebrate... Or Is It?
 

No... none of us can get out alive.  This may sound morbid, but it is true.  At some point it will all come to an end.  For some, it happens all too soon and for others, the process of dying can be long, drawn out and painful.  It is something we seldom talk about.  Death is far removed from our everyday life until it strikes a friend or family member.  It is at times such as this that we more seriously contemplate our own mortality and put life in perspective.
 

The statistics are telling us that we are living longer than ever before.  We now have medications and treatments that were never before possible, but when that time comes... what are your wishes?  Have you discussed your wishes with your family?  Have you filled out an Advanced Directive telling what your wishes are?  Does your doctor know what your wishes are?  And then, what if you change your mind?  (Yes... you always have the right to change your mind.)  These are all important questions to ask, as I truly believe that each of us should have a say as to how our life will end, when possible .
 

Having worked as a critical care nurse for 45 years at the bedside, I have seen death up close and personal.  I have talked with patients and their families about their wishes.  I have been there to prepare the families as well as when patients have taken their last breath and I have been there to comfort the families.  As a professional, it is important to be objective and non-judgemental.  Never would I impose my own personal beliefs at a time like this but rather, I would be supportive to the beliefs of the patient and family.  This is so very important.
 

You see, I do not believe in a heaven or hell.  When life is over... it is over; however, I have seen religion comfort families believing their loved one is going to heaven to be with someone else who they loved.  This comforts many families at such a difficult time in their lives.  There are a multitude of cultural implications at the time of death and many ways to handle it.  As a nurse, I was there to comfort the family and to provide pain relief to the terminally ill patient and to respect their wishes and never to interject my own beliefs.
 

Most of the time, the patient would be put on a morphine drip and the rate of the drip would be titrated to comfort.  I always explained that it may indeed hasten death in that it might drop the blood pressure further or diminish the respirations but it would promote relief of pain and anxiety.  The family would express understanding as they sat at the bedside watching the drug take effect.  This was no doubt a time of reflection, thinking of their loved one in years past as well as reflecting on their own mortality.
 

Compare a death such as this with one where there is a cardiac arrest and the patient is suddenly unresponsive.   In the hospital, alarms sound and doctors and nurses begin CPR, putting tubes in your throat, and needles in your veins to give emergency medications in an attempt to restore life; however, not all patients would want this.  I think if there is a reasonable chance of survival, most people would want to take that chance but for many, their past history with debilitating illness may cause them not to want this aggressive approach. 
 

But who makes the decision as to how aggressive treatment should be?  Each individual person needs to make his own decisions, and these decisions can be made long before the time comes in the form of an advanced directive.  This is quite simply, a document (known as an Advanced Directive or Living Will) telling your wishes to both your doctors and your family when you are faced with a terminal condition.  It also lists who you would choose to make these decisions if you were incapable of making them based on the contents of your Advanced Directive.   It does not require a lawyer to fill out but rather two witnesses to your signature who would not benefit in any way from your demise.  No money changes hands when you fill out such a document.  I personally filled one out years ago before having an ablation procedure to my heart. 
 

The problem comes because few people talk with their families or fill out such a form.  It is not until faced with a critical situation that this may come up and for this reason we are again hearing about physicians talking with patients about their wishes and Medicare is now going to reimburse doctors for their time to do so.  Medical care is very different from years ago.  The human body can be kept alive for extended periods of time thanks to drugs and what we call life support, such as ventilators and dialysis.  Technology is amazing!  
 

Unfortunately patients do not have a full comprehension of what this may entail.  It may be beneficial to some or it may prolong their misery and pain without quality of life and this is where the doctor must provide guidance as well as information.  To not do that, would be ethically wrong in all due respect to their patients.  Do you want to be resuscitated or do you want to be a "DNR" (do not resuscitate)?  Do you want a feeding tube?  Would you want to be an organ donor and what does that entail?  So many questions! 
 

I guess the thing that troubles me a bit, is that doctors will be getting paid for this conversation and my understanding is that each time it is brought up, they can charge again and be paid by medicare or the insurance company.  To my mind, it should simply be a part of quality care for the patient.  I do understand that time is money, but somehow it does not seem right to bill for this.  It is quite simply, the ethical and right thing to do.  We will hear much more about this in the coming months.
 

If I could choose how I would want to die, I would want to be at home in my own bed covered with a special quilt, with my little dog by my side,  and my loved ones in attendance.  I would want drugs to help me pass on as peacefully as possible as opposed to being in a hospital connected to a multitude of tubes and wires with strange noises and alarms in the background.
 

If the time came when I knew I was terminal and chose to end my life, I would personally want the opportunity to make that decision and choose euthanasia.  Of course, the laws have not yet caught up with this scenario.  I truly believe we all have a tolerance level and it is a very personal decision that only that individual could make for himself/herself. 
 

In my career I have seen both good deaths and bad deaths... and when I say bad, I refer to those where the patient or the family wanted everything done but in so doing, the dying process was simply prolonged making it so much harder on the patient and family alike.  I have also seen deaths that in spite of being in the hospital, honored that person's wishes and gave the family private time at the bedside. 
 

There was a teenage son that sat by his mother's bed.  She was dying of cancer and he strummed the guitar softly as she was taking her last breaths.  Or the family that sang hymns together at the bedside.  Or the mother who cuddled her dead toddler in her arms and rocked and sang to her for nearly 30 minutes.     
 

And then there was the older man who married a younger woman and they had their first baby who was just a few months old.  His dying wish was to hold his baby again.  He knew that his prognosis was not good as he was in cardiogenic shock with many wires and IV's maintaining his life minute to minute.  It was against the policy of the ICU to allow babies in the unit.  I pleaded with my supervisor to allow his wife to bring the baby in.  She conceded.  I put a soft towel over his chest to cover the wires and his wife brought the baby in and laid her on his chest.  He put his arms around her and a few tears moistened his cheeks.  His breathing became a bit less labored and both he and the baby fell asleep.  It was a few hours after his wife took the baby back to the waiting room that he lost his battle to survive but I knew that we had done the right thing.  Sometimes rules are meant to be broken.
 

I suppose the purpose of this blog entry is to say... make your choices wisely knowing that you can change your mind at any time, and then go out and enjoy your life. 
 

To read more about Advanced Directives/Living Wills: http://www.nlm.nih.gov/medlineplus/advancedirectives.html  Keep your advanced directive in a place at home where your family can find it if needed and each time you enter the hospital, have it with you so a copy can be made.  A new copy should be made with each admission.  This is where I keep mine amongst my collection of cookbooks.
 

    "May the spirit of nature bring you peace and joy."
 

Make the most of each day!  Live one day at a time.  Spread happiness to those you meet along the path of life.  Something as simple as a cheerful "hello" and a smile can be uplifting.   We have no idea what that other person might be dealing with in his life on that particular day. 
 

Today... I celebrate 70 years on planet Earth.  It is certainly the decades that stop you in your tracks and give you pause as to where you have been and where you are going.  I truly believe it is the simple things in life that are most important.  Be thankful for the time you have been given and enjoy something out of every day.  Don't get bogged down in the details.  Live each day like it is your last.  Well... just don't eat ALL the ice cream!