Medical Directives

I hesitate to write this because, first and foremost, I want people to take the time to prepare a medical directive for their loved ones. So, let me say first, get a copy of the Five Wishes OR meet with an attorney to write out your directions in a Living Will. (Don't do both as far as the Medical Directives are concerned because they can supercede each other.) This is a great kindness you can do for your loved ones when they are brought into a hospital conference room and asked, “Do you know what XXX would want done at this stage in her life?” And do this now. Whether you are 23 or 83, there is no time at which it is too soon. There is only the time when it is too late.

So, that said, I want to share something about medical directives that partly comes from my most immediate experience and partly from my experience as a chaplain. My mother had some medical directives before she died. And she had shared what her wishes were with all of her children. So, we knew that she wanted to be kept on life support for at least two weeks beyond the point when the doctors felt like she was no longer going to recover from whatever illness or injury had befallen her. She made this directive, in part, because her own mother had had a catastrophic fall which she fully recovered from despite being in a coma. Years later, when her own mother did die, she felt that the doctors had pressed her and her sisters to let go too soon.

This is what I WISH I had been able to communicate to my mother about that experience and what I want YOU to know.

Medical directives are fantastic things that help your loved ones make difficult decisions when you are no longer capable or temporarily incapable. BUT, sometimes, the choices you have set in your medical directives are not truly available, not in a meaningful way.

The most obvious example is say you had a directive like my mother’s to be kept on life support for two weeks beyond the point when doctors said you were beyond recovery. But, if you are in a catastrophic car accident where you die on the scene, that is not an option you or your family are going to be able to exercise. That is an extreme example for the purpose of making the point that some decisions are not always within our reach.

So, I will share with you my mother’s case because she had created her medical directive with a specific scenario in mind, where something catastrophic but not immediately fatal had happened.

At the end of her life, my mother was on dialysis because she had experienced a kidney injury that had cut off the blood supply to her kidneys. On top of that, her liver function was already decreasing rapidly to the point that I was on the verge of meeting with a transplant team to be her donor. Without a liver transplant, she may have had five years to live.

Then, she got MRSA, a frequently deadly infection that is resistant to anti-biotics. Her body went into acute failure very quickly. THIS is not the situation she had planned for. This is not a stroke where the brain has been compromised and may or may not recover. Instead, her internal organs were slowly but steadily shutting down. Her medical directive “to be kept on life saving measures for two weeks beyond the point where doctors said that she won’t recover” was not an option in this instance.

That’s not to say we couldn’t have tried. We could have directed the doctors to keep increasing the blood pressure medications (as her heart grew weaker and was not pumping blood as strongly) and keep her intubated to make sure that oxygen was being forced into her lungs, and keep doing all the other remarkable modern life saving measures that extend life far beyond what would have been possible 50 years ago. But eventually, THIS is what would have happened. (And when I say eventually, I mean even within the same day as the day she did actually die.) Her heart would have started to fail and, following the medical directives she had on file, the doctors and nurses attending her would have been required to perform CPR.

If you have never seen CPR performed, particularly in a hospital setting, it is not the antiseptic experience you see on TV or if you’ve ever taken a CPR class. CPR can be, to put it plainly, a violent act. When the electric current doesn’t restart the heart, as it often does not, the nurses have to take turns doing chest compressions on a reluctant heart. To be effective, it is not the subtle pulses on a mannequin to the rhythms of “Stayin’ Alive” that you do in CPR class. Ribs often get cracked. I’ll spare you the other details but it is not easy to watch.

THAT is the fate that awaited my mother if we had enforced her wishes. It is VERY likely that she still would have died that same day but after a lengthy series of attempts to resuscitate her. The truth of the matter is that her wishes were not a viable option. We were not working with the circumstance she had imagined when she wrote her directives. And that is what would have happened to my grandmother at the end of her life as well. I wish I could have shared this with my mother. She struggled with the way Nana’s life ended.

By all means, CREATE your medical directives. Let your loved ones know what your wishes are given the circumstances you can imagine. And then, let them know that, when the time comes, they will have to make the best decision possible given the actual circumstances they are presented with. It is one of the most loving things you can do for anyone who loves and cares for you.