Ten years ago, I cared for an elderly man dying of heart failure in the emergency department. He refused life support and received comfort care. Still, the nurse and his wife took turns yelling, “Breathe . . . breathe . . . breathe!” The disrespect shown to this gentleman taking his last breath prompted me to “say something” through blog posts, speaking presentations, and Dr. H’s clipboard. My tips for advance care planning were intended to prepare people to think first before reacting fearfully to death.
I recently learned that a 96-year-old man fell into a ditch while getting his mail and laid there nearly dying. His wife immediately called 911 and he was resuscitated at the hospital. While he did have an advance directive refusing life support, others felt compelled to save his life. Why didn’t the paramedics use common sense and calm the wife’s emotional state? Would it have been wrong for the paramedics to think first, carry this man to his own bed and allow nature to take its course?
In a world where common sense and political decency seem to be in short supply, reasonable end-of-life conversations are rarely being held at round tables or dinner tables. It’s likely that some things will never change. In trying to beat the odds of a massive heart attack, one 99-year-old man stated, “What do I have to lose?” That’s human nature speaking. Common sense would suggest that he’ll experience a fate worse than death.
The purpose of building a strong foundation for advance care planning is to think first before reacting. The goal of having a strong foundation is to be willing, able and ready to seize the hour of death when the time comes. While human nature often works against forces of nature, common sense exists in harmony with Mother Nature.
Dr. H’s legacy of advance care planning has spoken to the heart of an individual’s willingness, ability and readiness to accept fate and rest in peace in the following ways:
Think of dying as the icing on the cake, satisfying a sweet craving to top off a good life. The goal of writing Wishes To Die For was to help people overcome human nature (fear) through spiritual directives (wishes), prompting self-determination along the way to a good death. My educational platform of Graceful Departures evolved from the desire to offer patients a rewarding end-of-life experience.
Most people procrastinate in completing advance care directives. While not attempting to change human nature, I did propose the Universal Healthcare Directive. Seemingly, we all experience the willingness to live, survive and die and need advance, palliative and end-of-life care respective to each these conquests.
Caregivers (paid and unpaid) are often willing to do the unthinkable and carry the brunt and heartache of bad medical decisions. Their moral authority holds dominion over the life and death of loved ones, yet there’s no law recognizing good conscience as common sense. I proposed The Caregiver’s Good Conscience Law to provide immunity for those willing to show humanity by comforting the dying.
Nurses do a better job of training future physicians than medical schools about compassion. I created The Gateway to Palliative Care through the ER: A Nurse Practicum and New Perspective for End-of-Life Care online, assigning responsibility for the holistic aspects of life-and-death care to nurses. Physicians often lack common sense with conflicts of interest. Nurses have more hands-on experience and the innate ability to connect with the hearts of family caregivers.
To meet the needs of patients preferring to die in the comfort of their own homes, I‘ve championed home-based palliative care for all chronic illness patients. My booklet, “Is Palliative Care Right for YOU?” helped give patients the ability to move beyond the insanity of doing the same thing over and over again by encouraging them to say – “I receive palliative care.” This booklet included the necessary patient’s palliative care rights.
Family caregivers pine for support, but they need tools to avoid feeling helpless. I shelved my ready-made book, “The Four Seasons to Caregiving.” The four seasons provide a perfect template for family caregivers to manage their lives in intervals of three months. Yet, I’m not convinced caregivers are ready to place the same limits on their loved ones’ lives.
Family caregivers need a backup advance directive when patients fail to complete their own. The Advance Directive Decision Tree for Caregivers can help family members think like an ER doctor and ready them to make common sense life-and-death decisions for their loved ones.
Few people want to discuss the end of life, so I’ve proposed ‘Strategic Aging” as an alternative conversation that physicians might have with their Medicare patients. The three holistic talking points of strategic aging include 1) prioritize quality of life (mind), 2) manage chronic illness (body), and 3) appreciate palliative care (spirit). Strategic aging prepares patients with life-limiting illness for the inevitable and averts the final life-threatening emergency.
The book, Aging in Arizona, included my chapter Final Wishes. Readers can learn how my seven final wishes need to be applied to every medical decision before reaching a final decision. The first wish for composure is what’s needed for people to overcome human nature. The last wish for comfort makes use of common sense for those wishing to rest in peace at the end.
While it’s human nature to run to a doctor when something is wrong, people who use common sense realize that there’s nothing wrong with allowing a chronically-ill person to die. Yet, the healthcare system does not support this type of thinking and often tempts patients to “hang in there.” The suggestion that “less is more” often falls on deaf ears. Changing the world takes courage and leadership. Changing human nature and the healthcare system appears a futile investment of time and money. Hence, my decision to hang up Dr. H’s Clipboard.
The dark side of human nature often appears inhumane and merciless. This haunts each of us who make bad medical decisions. Using common sense for patients near death likely comes across as offensive and insensitive to patients who are not yet willing, able or ready to die. This damned if you do and damned if you don’t say something stirs up the age-old, unresolved battle between human nature and Mother Nature.
As a disruptor and peacemaker, Dr. H aspired to have people view human nature as existing in harmony with Mother Nature. But the healthcare system portends that people can fool Mother Nature through receiving artificial life support. Advance care planning that includes self-determination, patient autonomy and, personal responsibility is the path to a good death. Yet most people forsake their own dignity by fighting harder, resigning to fates worse than death and failing to experience “graceful departures.”
With the end of Dr. H’s Clipboard, I anticipate a new beginning in the New Year. While my newsletter has not changed the world, it has strengthened my willingness, ability, and readiness to change the way people die in this country one patient at a time. It’s heartwarming to know that my contemplative path over the past ten years has led others (including my parents) to a better place of acceptance, fulfillment and everlasting peace.