Do Not Resuscitate
A difficult end of life choice
As my loved ones get older, their end-of-life choices has become a reality in my life. I’ve recently realized there are a lot of things that I’ve never considered.
Making an end-of-life plan
I understand this might be difficult to think about. Death doesn’t come up in day-to-day conversations unless you own a mortuary or sell life insurance. It’s not a casual topic to bring up over a coffee with friends.
— — — — — — — — — — — — — — — —
It all started when my mother asked me to attend a meeting. In our province, the program is called ‘Advanced Care Planning’. It’s intended to start a conversation between seniors and their adult children or their doctor.
The program is supposed to help you make a plan that outlines what you are willing to accept when you are ill or injured and can’t make decisions for yourself.
Where will you draw the line?
We arrived at the library on a Tuesday night and took seats near the back of the room. There were a lot of people already there; many were with a friend or younger relative. When two young women stood up at the front of the room, the chatter quieted down.
They started slowly, asking about our beliefs, wishes, and values.
This gentle approach was an attempt to sneak up on harder questions like ‘Do you want oxygen when you can’t breathe’, or ‘What kinds of permanent supports are you willing to accept to keep you alive for longer?’
I thought it was pretty clear-cut.
Yes, I would be OK with oxygen if I was having trouble breathing but no, I wouldn’t want to live with a permanent tracheotomy. That kind of thing.
— — — — — — — — — — — — —
Then one of the ladies told a story about a friend of hers.
It was another nurse, knowledgeable in all things medical. She had made a plan and her friends were aware of it. She said she would never want to be on a ventilator for more than 10 days. She’d chosen 10 days because she knew it was policy to do a permanent trach on a patient after 10 days. She didn’t want a permanent breathing tube.
One day at work, she passed out. They rushed to her side and did everything to stabilize her. Because she was unable to breathe on her own, they intubated her as they took care of the medical problem. When she was stabilized, they tried to take the tube out, but every time they started to do it, she would go into respiratory distress and they couldn’t do it.
Every day, they’d try again, without any luck. It started getting closer to her 10-day limit.
The problem was a fluke thing, something to do with her heart, and she had been lucky, but now there was another concern. She was approaching the moment where her wishes were for the team to remove the ventilator, even though she wasn’t quite ready to tolerate it.
The hospital was required to follow the plan, even though in this situation they knew their friend wouldn’t want them to follow it as it would likely end her life.
So, the doctor and the friend talked about it, and agreed to loosen the rules — it was just enough for her friend. The next day she was able to get off the ventilator and she recovered completely.
When we left the meeting, my mother planned to fill out her wishes. When we met again, we could finalize it and send a copy to her doctor. She couldn’t do it.
That was two years ago.
For two years, I gently reminded her to fill out the forms. There was always an excuse. I kept telling her I didn’t want to have a conversation in an emergency room. It was better to sort it out ahead of time.
At one point she ‘lost’ all of the documents and we had to replace them. The situation was frustrating and it was causing a rift between us.
She wanted to have a plan but in her words “I just didn’t realize how hard it was.”
Then things changed for me
I went into AFIB while I was sitting at my computer. At rest, they called it. It was a bit unusual to have your heart race when you’re just sitting there. Most people go into afib when they are exercising or stressing themselves out.
After a couple of uncomfortable hours, I went to emergency. After hooking me up to a heart monitor and taking blood, I spoke with the doctor on call.
He told me I had two options. He could cardio-vert me or send me home.
A cardio-version is when they use the paddles to give you an electric shock. It’s intended to put your heart back into a normal rhythm.
Yup, just like in the movies. Bu-boom.
When the doctor discovered I wasn’t on a blood thinner, he recommended against it.
“I wouldn’t do it if it were me,” he said. “the fibrillation has probably created some blood clots in your heart, and the shock might break them loose. You could have a stroke and lose all your function.”
Great, I thought. I could die right here. I could end up in a coma, and my spouse would be the one having to make those hard decisions.
Right there, we had the end of life conversation.
The one I said I never wanted to have with anyone in an emergency room.
The one that my mom was reluctant to have.
Now that I’m home again, I’ve decided it might be time to take a closer look at my options. I don’t want to put my partner in the position of trying to figure out what I would want.
Most of the plan is straightforward.
Who is your person? Who do you want to make decisions for you.
List their contact information.
List the things you won’t accept. This is the one where it gets tricky.
As far as I can see, there are three main areas to look at.
1. Nourishment
2. Breathing
3. Resuscitation
** Remember, these answers are for when I’m not able to make my own decisions.
I figure that I’ll be in a coma, or paralyzed and can’t communicate. My personal decision is this:
For nourishment, I’m ok with an IV saline or a fluid diet, but a permanent feeding tube. Nope.
For breathing, I’m ok with a tube to help me breathe during surgery or when I’m in some kind of respiratory distress, but a tracheotomy to put a permanent breathing tube in. Nope.
If I’m dying after a long illness and it’s not reversible, let me go. DNR.
My main rule is this: I don’t want to be kept on a machine if there’s no hope that I’ll get better and go home.
Now, everyone else will have different choices and I accept and respect that. The thing is letting your person know what you want.
If they don’t know, they’ll likely choose what they’d choose for themselves.
And you might not be happy with that
(A note to any of my loved ones, if you don’t make a plan, this is what I’ll decide for you.”)
I wrote this because I started thinking about how we focus on meaningless things in our daily lives, instead of making end-of-life plans.
So I hopped down a rabbit hole:🐰🕳
Questions for you:
Do you have an end-of-life plan?
What is your bottom line in the event of a major illness that you aren’t likely to recover from?
If you had a nothing box, what would you do with it?
Please answer in the comments below.
Funny, I've thought about this lately for myself, and you've written about it. Such helpful details, my friend!
Important topic, Tree. Thank you for writing about this.