End of life – things to consider

At the entrance to the pearly gates, there may be a lot of things you wish you had considered earlier.  Someone with better qualifications than me will have to help you with that struggle.  I went to Catholic school through college so while I am certain there is a heaven, I know I will be spending some time in the waiting room before I get in.  Today, I want to focus on the moments, be they brief or long, before you take your last breath and let go of all that grounds us.  I hope if you read yesterday’s entry, you are considering making a living will or at least, appointing a health care proxy.  Here are some of the important issues that you need to consider before you write it all down or have a very serious conversation with the person you appoint.  Please don’t just say, “You know what I want.”  Believe me, they don’t.  There is no right or wrong answer.  Also, remember that this is only in the case that you cannot communicate and there is no hope for any kind of normal survival.  You may be an optimist and think that there is always hope.  I am a pessimist and you would be wrong.

1.  Organ donation – Do you want to donate your organs?  Almost everyone has something to donate.  Your age and your health status don’t necessarily preclude you.  You can be very specific and pick which organs you would like to hold onto and which ones you wouldn’t mind getting rid of.  I used to specify that I wanted to keep my eyes so that I could see my way to the light.  Then I realized that I am an idiot.  You can refuse to give anything though for any reason but no one wants your appendix, your gallbladder or that weird lump on your head.  For a little more info on organ donation, look back to Dec. 21st.

2.  CPR – cardiopulmonary resuscitation describes the first steps that are used when the heart and breathing stop.  The techniques that are used are very similar to what you have seen on ER minus the drama, the gorgeous people and the commercial breaks.  When done on a terminally ill patient, if it works, it is usually followed by medications to keep your heart beating and mechanical respiration.

3.  Mechanical respiration is having a breathing tube inserted into your trachea that does your breathing for you.  It controls how fast you are breathing and how much air is going into your lungs.  People who are on respirators and who are making a recovery are usually weaned off very slowly and carefully.  Patients who are brain dead or terminally ill are often unable to breathe without a respirator.  To take that person off the respirator is unfortunately referred to by many as pulling the plug.  It is a very big deal medically and ethically and is, therefore, not as simple as it sounds.

4.  Tube feeding – If you are in a hospital setting, you will likely be getting IV fluids with some minimal nutrition being delivered that way.  If you are unable to eat, doctors will insert a tube into your stomach either through your nose or directly through your abdomen into your stomach and deliver your nutrition that way.  You can refuse this or if you’ve always hated dieting, you can say that you would want to be fed in this manner.

5.  Antibiotics – Often in a hospital or hospice setting, gravely ill patients will succumb to an overwhelming infection like pneumonia,  before they die from their disease or injuries.  Not allowing antibiotics to be used in this circumstance can speed up the process.

Other than dying, most people are very afraid of pain – which I covered last week.  Maybe next week, I should discuss spiders and snakes.  What is wrong with me?  Anyway, you can and should be very clear that you want maximum pain medication.  Remember, you are already in a state of being unable to communicate so it is not as if you will divulge all your secrets or slur your words in your doped up state.  I didn’t even include it in the five above because this one seems like a no-brainer (no pun intended.)

Tomorrow, the logistics of getting your living will and/or health proxy done.  It’s easy and like saving for retirement, you are never too young.

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