How To Make A Mask For A 3 Year Old Advance Directive Warning

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Advance Directive Warning

Looking for. 1:30 Saturday morning, December 18, 2010

“I think I need help!”

Mom is standing in front of my bedroom door, gasping for breath and writhing in pain. She says she waited an hour before waking me up.

(Story: When I arrived last night, Mom told me that sometimes she feels “uncomfortable” at night. Knowing that she had suffered a major heart attack a few months ago, I prayed that I would be there if it happened again.)

We call 911 and give them the information. They tell me to make sure the animals are secured and the door is open. I say, “I can’t leave my mother.”

After what seemed like 10 minutes, I called 911 again. “I’m at the door,” says the dispatcher.

There are two paramedics and four firefighters, including the captain of the fire department. Some give first aid, others ask about the Mother’s Advance Directive. I found it and said it doesn’t say not to treat it.

We arrive at the hospital, a renowned treatment, research and teaching facility. Dr. C. (a cardiologist) and Dr. N., as well as numerous other staff, attend to the mother.

They are very concerned about their Advance Directive. Again, I pointed out that he doesn’t say to treat her unless she’s in a coma, and she’s not.

“She is very, very sick,” they say. “What would she want?”

In tears, I tell her: “I know what she wants. She is a very happy person. She loves life. She is going to my brother for Christmas. Her great-grandchildren are coming to visit next month. She does not want to go. in any place”.

She shows one of the doctors the part of her Advance Directive that says she does not want to be kept in a coma or vegetative state with no hope of recovery. “He’s not in a coma,” I say. He looks meaningfully at his motionless form, attached to the machines.

If I had my wits about me, maybe I could say something like, “If you brought in a 20-year-old football player who had just had a massive heart attack and you administered morphine, how sensible do you think he would be ? be? And would you be so quick to write it?” But I cannot form these thoughts, let alone express them. I just have the feeling that there is something wrong with the doctor’s reasoning.

They talk about the possibility of surgery to save his life.

I’m calling my brother, Jamie, and his wife, Shelly (a geriatric nurse). Shelly thinks mom will die without the operation. So do doctors. Jamie and I give permission.

Jamie and Shelly arrive at the hospital.

Doctors decided against surgery. Too risky. We agree.

Dr. N. wants to discuss the options here, in front of the mother. But I’ve read that coma patients – or apparently coma patients – sometimes give up and die when they hear a negative prognosis.

I say “Not in front of her”, and we go to the Quiet Room. Dr. C. also explains that surgery is not an option. We agree.

Dr. N. wants to end medical treatment (IV medications). He tells us about an experience in medical school when the professor made it difficult for the students to breathe, and recounts his terror. She believes she is suffering and is sure she will “never regain cognitive function.”

I want her to see her grandchildren and great-grandchildren, some on the road and some here in town. “I don’t know them,” says Dr. N.

“Are you sure?”

That’s for sure.

He talks more about how he suffers. I don’t remember the wording, but I believe there was some indication that he was already in a vegetative state.

Jamie and I have allowed the medical treatment to end because the mother is probably suffering intensely and will never regain cognitive function. Just before giving the final permission, I look to the sky for wisdom and believe that the answer I hear is yes.

They maintain the same dose of blood thinner, but decrease the dose of medication that maintains the mother’s blood pressure.

[I’m calling what happened next a miracle, but may never know, at least not in this life, how it happened. Perhaps Dr. C. didn’t want to disagree with Dr. N. in front of us, but quietly went ahead and did what he knew was right. Or perhaps–and this may be more likely–they maintained the one medication and only lowered the other one in order to give Mom a quiet passing, without another cardiac event that would clearly upset the family. However it happened, I believe that I heard “yes” not because it was the way to go regarding treatment, but because the answer satisfied Dr. N. and made way for what followed.]

The mother’s blood pressure drops. We gather around to sing and pray. Through her mask, mother says, “I have so much to be thankful for.”

“Thank you for being here with me,” he says to each of us – Jamie, Shelly and me.

“I love you, mom” I say.

“I love you too,” she replies.

We recite Psalm 23. When we get to “Surely goodness and mercy shall follow me all the days of my life,” Mother joins in. (He remembers this later).

The chaplain sings “Be Thou My Vision,” Mom’s favorite hymn.

We sing “Amazing Grace” and “Jesus Loves Me.”

I recite John 3:16 (“For God so loved the world…”) and John 1:12 (“All who received him…”)

“I can’t speak very clearly,” the mother apologizes through the mask.

“Yes, you can,” I countered. “You just said, ‘I can’t speak very clearly.'” She laughs. (Mom remembers this later.)

We watch as the mother’s blood pressure stabilizes, then begins to rise. My nephew is coming. Mom thanks him for coming. His sister is coming. She and mom talk briefly.

Jamie and Shelly’s friend comes over. They joke about the last time he came to see her in the hospital, and took her a bed by the window.

The mask is uncomfortable and no regulation can be right. The staff will replace the mask with tips.

Mom sits down and talks freely. I’m making a joke. She laughs, and the monitor shows deeper breaths.

He wonders why everyone looks so sad (he remembers this later), and…could he have some breakfast?

After tea with toast and jam, the mother is moved upstairs to a cardiac unit. My husband, our daughter and our son are arriving. Mom is happy to see them, but sorry that she worried them. Another phone call from our girls and she and mom have a nice chat. Mom is happy, but just a little disappointed that my brother can’t get the family’s Nicaraguan connection on Skype.

He will never regain cognitive function… he doesn’t know them.

Later in the afternoon, he moved to another neighborhood. When we leave for the night, mom says, “I had a wonderful time.”

On Sunday the mother enjoys more visitors and a newspaper crossword puzzle.

On Monday Dr. A, another cardiologist, makes his rounds. I ask her, “If a 90-year-old had a heart attack as severe as Mom’s, would you say she would never regain cognitive function, based solely on her age and the severity of the attack?”

He seems surprised by the question. “Total loss of cognitive function? Did anyone tell you that?”

Yes, I answer without elaborating.

No, he replies, he would not have predicted it. In fact, mom might be home for Christmas, and she should be able to continue living in the same situation.

She and I enjoyed a Christmas carol concert at the hospital in the afternoon.

In the evening, he finishes correcting his nephew’s introduction to his honors thesis. She found a few minor errors and looks forward to reading the document when it is finished. Mom wonders if a photo of the man my nephew is writing about might be helpful. Found one on the internet last year but can’t remember the website. I noticed the tip on my nephew’s paper.

Mom is writing Christmas checks for the grandchildren and great-grandchildren, and asks Jamie to bring in the crossword puzzle tomorrow.

she doesn’t know them

On Tuesday, a medical student informed us that there was no significant new damage to the heart from this, Mom’s second heart attack.

Mother is released Wednesday afternoon. She delivers thank you cards to the cardiac ward and the Emergency Department.

Pity the poor employee in Emergency. Although the mother brings the card to her in what is obviously a greeting card envelope, the woman thinks it is her Health card. (Think maybe they don’t get many thank you cards in Emergency?)

My concerns with the Advanced Directive, at least as we wrote it, are as follows:

1. A doctor who favors the premature termination of the elderly (my term) can interpret terms such as “in a coma”, “in a vegetative state” and “without heroic measures” in a way that neither we nor our loved ones would like

2. In a slightly different case, I have a friend who watched helplessly as his father gasped for breath. Apparently, the staff had interpreted a previous oral instruction not to use a feeding tube to mean “no intervention”; so they ignored my friend’s pleas to give him oxygen. She finally called 911 and paramedics administered oxygen to her father at the hospital. He died a week or so later, apparently in relative comfort.

We will never know if this man was allowed to suffer as he apparently did (there is no proof, obviously) because the staff truly believed that no feeding tube meant no oxygen, or if they simply felt that it was an old man with advanced Alzheimer’s that time. he had come

My father died in the same hospice facility. He had specified “no heroic measures” and was given both a feeding tube and oxygen as well as painkillers. I believe he died in relative physical comfort. Maybe it depends on who is working that night, or if the patient has Alzheimer’s, or what is with them at the time. The father’s mind remained clear and he was able to communicate orally and in writing until he slipped into a final coma. Also, his highly vigilant geriatric nurse daughter-in-law was at his side, along with the rest of us.

I once spoke to a nurse who said she refused oxygen to patients who pointed to the mask, asking clearly, because of previous instructions. She said she only held these people and tried to comfort them as they died.

It appears that even a properly written Advance Directive can result in unnecessary suffering and premature death.

The solution that my brother and I are considering is simply a list of agents with complete contact information so that decisions can be made at the moment.

However, we have to be very, very vigilant when our loved ones cannot speak for themselves.

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