As a geriatrician, I work every day with individuals with changing health. Discussions of disease, functional changes, clinical decline, and end-of-life care are very common. I routinely encourage people to consider health options, make treatment choices, and share these through discussion and advance care planning documents.
But suddenly it was personal.
I got the phone call no child wishes to receive. When I arrived at the hospital my father lay unresponsive on the emergency room cart, my mother at his bedside. My father’s normally smiling 94-year-old face was blank. There was no response to my voice or touch. His pulse and blood pressure were worrisome.
My physician brain instinctively realized he was probably dying. As a son, my heart cried out against the end of life for this vibrant and compassionate man. A man who had given life to me and six siblings. A man who had given his heart and soul to family and church. A man who had survived other serious illnesses.
Of course I did not want him to die, but even more, I did not want him to endure a prolonged dying in a sterile medical environment if death was inevitable. I knew the many possible medical treatments – the harder part was deciding which things should be done.
Understanding my father’s wishes
I turned to my mother, starting my usual medical discussion of code blue, mechanical breathing, and medical heroics. She listened briefly, and then said, “Oh, we discussed that several weeks ago with our doctor, and completed a paper about those wishes. The paper is over there on the counter.”
They had discussed and completed a POLST document (Pennsylvania Orders for Life-Sustaining Treatment). It is one of several documents used in the advance care planning discussion to document the wishes of an individual. The POLST form is used for people with significant illness, and allows specific medical orders about resuscitation, medical interventions, antibiotics and feeding tubes.
Based on this document, I quickly confirmed with my mother that they did not want a code blue, mechanical breathing or invasive life support. They would accept medications and comfort treatment. The document clearly established his wishes for the medical team. As a son, the document gave great comfort to our decisions, knowing we honored his values.
Based on his wishes, we chose supportive care, focused on comfort. If he had died, we as a family were at peace knowing that we followed his wishes. Remarkably, he slowly improved and returned to independent living. I’m delighted to still have him in my life, but I know his wishes if we face a future similar situation.
An ongoing discussion for people of all ages of life
Advance care planning is an ongoing discussion about life priorities and goals, an evaluation of options, a choice about how we want to live, and a sharing of that through conversation and documents.
Advance care planning was essential for my father. It is important for me at mid-life. It is appropriate for my young adult children. The priorities are different at various stages of life, but everyone after age 18 should consider and document the appropriate portions. Talk with your medical provider and family about your goals.
My father gave my family a great gift by having this discussion before his illness. Please give yourself and your loved ones the gift of having this discussion in the near future. It’s one of the most important conversations you can have.