Saturday, July 14, 2012

Why must I think and talk about end of life now?

You may ask why it is necessary to talk about end of life while you are relatively young and in good health?
There is no question that the end is coming and we will have to embark on this journey for sure. How to best prepare for it so it is painless as possible is the task before us all.
The problem is that most Americans want to die at home with their loved ones around. But unfortunately only about 30% of them do.
Over 50% die in hospitals, many in the intensive care units and on machines and following attempts on resuscitation; not a very dignified and gentle way to go! The remaining die in nursing homes and other long term facilities.
Take the case of Mrs M who was 93 yrs old, had dementia, was totally bed bound with flexion contractures of her extremities, bed sores and on tube feedings in a nursing home. She started to run fever, got sepsis (blood borne infection), difficulty breathing and was brought to the hospital.
She was admitted to the ICU and put on a ventilator. There was no advance directive and the family had not had any conversations about end of life with the patient. Family wanted everything done. When she had a cardiac arrest, she was resuscitated followed by two more arrests and attempts at resuscitation before she died! I am sure Mrs M did not wish to die in this manner, but she never talked to anyone about it while she had capacity to make her own decisions.
I can share hundreds of such true stories with you. Let us make sure yours is not one of them.
One may lose mental abilities to make decisions at any time due to multiple reasons. For example, severe illness, meningitis, dementia, trauma to head/ brain, intracranial bleed, stroke, neurologic disease, brain tumors, metabolic disease etc. 
Thus it behooves us to be proactive and talk to our loved ones about how we want to live if we are on life prolonging treatments so that our life is meaningful, as defined by us!
It is one of the best gifts you can give your loved ones. They will be eternally grateful that they did not have to make the hard decisions at the end, because you had already defined as to what kind of existence was acceptable to you!!
That is why it is necessary for you, me, us all to think and talk about end of life and define our minimal acceptable levels of living when we are on life prolonging treatments.

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