In the prior post, Nancy described detection devices to prevent or report falls. I didn’t intend to write such a distressing follow up, but life has a way of bringing things up, whether we want to think about them or not. Recently, someone close to me fell and had seizures and a stroke. He got to the hospital, but he was unconscious. There was no one available to describe what he wanted the doctor to do in the case he could not breathe or his heart stopped. I am pretty sure he would not want to live unable to feed or take care of himself. But what were his wishes? I’m not really sure, and he could not say.
This incident made it very clear to me that every one of us needs a discussion with our physician about what we would want if we are unconscious and unable to speak for ourselves. There are several forms that should be discussed and put on file BEFORE you need them. One is a Do Not Resuscitate (DNR) order. If you fall, are not breathing and have no pulse, do you want the medics to treat you with CPR (cardiopulmonary resuscitation)? You may or you may not. It is your choice. A DNR does not explain to medical professionals about any of the subtleties of end of life care, and it does not mean “do not treat”. It simply addresses whether or not you want CPR.
A POLST is more helpful and descriptive. It is a one page document that describes a longer conversation between a physician and a patient about end of life care. It is broader than a DNR (but it includes a box to check for DNR) and outlines the patient’s desires regarding the level of care — comfort care, limited treatment, or full treatment. A POLST is a medical order that can be used by emergency medical personnel in any setting – a home, a nursing home, a hospital – but it must be discussed and signed BEFORE the patient is unconscious. The rules about POLST forms may vary from state to state, so check your state out and if you live in two different places, you may need one for each residence. (Here is a sample POLST from Harvard Health and some FAQs about who needs a POLST.)
What about an Advance Directive or Living Will? An Advance Directive is a legal document that describes the type of care you would want in an end of life setting. It may include a DNR and a POLST, as well as a living will. Obviously, all of these documents should be created while the patient is fully able to discuss the issues.
If you are reading this and do not have these documents on file, talk this over with your doctor right away. Whatever your age, you owe it to yourself and your family to make these very hard decisions a bit easier to make! And be sure that these documents are easily accessible, especially if you live alone. Some emergency personnel suggest putting the POLST or DNR on the refrigerator so that the paramedics can easily find it. (See comments for other suggestions about how and where to keep it handy.)
In the case of my friend, he recovered consciousness within a few hours and was able to take over the decisions related to his own care.
As always, we welcome your thoughts and experiences!