DNR and POLST Forms on the 8th Day of the Week

I once talked with my parents about their end-of-life wishes before dessert was served.

When Mom was alive, we talked every Saturday. I miss that. A pre-dawn riser by habit, I could phone her in California for a relaxed early morning chat regardless of where I lived. One year, anticipating Thanksgiving, our weekly ritual included my suggestion that she and Dad talk about a serious topic with their “kids.”

She agreed. At Thanksgiving, they’d let us know their wishes.

I did not anticipate this request would become Mom’s announcement after the second helping of turkey was offered, but prior to choosing between pumpkin or apple pie for dessert. With mashed potatoes cooling on my plate, with my two sisters and our spouses ‘round the table enjoying the Thanksgiving feast, Mom said . . .

“Larry thought we should tell you what we want when we’re dying. Your father and I don’t want to be hooked to machines keeping us alive. Just let us go.”

Those likely weren’t her exact words. But even if my smarter, better-looking sisters disagreed with my memory, that was darn close to what and how Mom announced their wishes.

Every family is different! Happy Thanksgiving, eh?

I would’ve preferred us in the family room, warmed by a blaze Dad got going in the fireplace, relaxed and sitting on sofas and chairs, with a brisk November breeze outside and thoughtful conversations on the inside. Though that Thanksgiving—for me—was memorable for my parents’ brevity, honesty, and finding a way to make homemade desserts taste awful, we did “talk.”

My parents also completed the proper forms available back then, including the DNR (Do Not Resusitate)* instructions:

A DNR order tells emergency medical personnel that you do not wish to be administered cardiopulmonary resuscitation (CPR). DNR orders are used both in hospitals and in situations where a person might require emergency care outside of the hospital.  In some states, DNR orders go by a different name, such as “Comfort One.” In other states, if you are using the document outside of a hospital or other health care facility, the document may simply be called a “DNR form.”

Good for Mom and Dad!

My wife and I have a DNR.

Do you?

Have you had a conversation with your parents? Children? Spouse? Significant other? Or with your two best friends (that are your “real” family) who’d prefer to talk football or fly fishing rather than death and dying? What have you told those who will, with deep anguish and great love, make life-saving or life-ending decisions if you can’t?

Have you talked with your doctor? Your priest (or rabbi or imam or minister)?

Here’s an answer too many give about their wishes: I don’t want to discuss my dying and death now or later.

Wouldn’t refusing to have any discussion make Thanksgiving dessert easier to swallow? Ignorance can be bliss . . . well, at least for a while.

My annual physical is next month, a visit I try to do every few years. I confess, I’m never thrilled with any doctor’s appointment. Maybe you enjoy waiting-waiting-waiting rooms with old magazines and graphic posters depicting the horrors of flu season and psoriasis. Not me, though.

This year I plan to add two subjects for our doctor-patient discussions. One involves a POLST* (Physician Orders for Life Sustaining Treatment)* form:

A POLST is often prepared to ensure that different health care facilities and service providers (including EMS personnel) understand a patient’s wishes. In most states, a POLST form is printed on brightly colored paper so it will easily stand out in a patient’s medical records. To be valid, the form must be signed by a doctor or other approved health care professional. Unlike a DNR order, a POLST form includes directions about life-sustaining measures—such as intubation, antibiotic use and feeding tubes—in addition to CPR. The POLST form helps to ensure that medical providers will understand your wishes at a glance . . . [Bold font and italics are mine.]

Since I don’t have a life-limiting illness, it’s too early to sign an official POLST. But I want my physician to know what I’m thinking now for my future. I want to know her opinion. Maybe we won’t mention it again for years—I hope so—but why not start a conversation now?

While at the doctor’s office and wearing a ridiculously thin paper gown (which, for people with, er, thick waists like me, never properly tie around the middle), I’ll also venture into the medical-aid-in-dying territory with my physician. In California (as with several states), adults with a diagnosis of six months or less to live, can—following rigid guidelines—choose medication to end their life. Do I have a terminal illness? Again, nope. But, also again, I want to know the doctor’s thoughts. And I want her, a person who may help me make health care decisions, to know what I think.

Who knows what you think? (Oh, I’ve asked that before . . .)

If no one does, what prevents you from having these life-giving, life-affirming, life-loving conversations? Could it be . . .

  • If you talk about dying, it’s bad karma and you’ll soon be facing death?
  • No one in your family ever talks about uncomfortable subjects?
  • You are part of a particular culture, religion or ethnic group that avoids this subject?
  • You’re not going to die, so why not have more dessert?
  • Anytime you talk about anything “important,” your loved ones argue.
  • You plan to have the talk tomorrow, on the eighth day of week or the 32nd day of the month.

I would’ve preferred a nice family discussion after the Thanksgiving meal was over. But we did talk. I did know what Mom and Dad wanted.

I will spend a moment or two with my doctor, desiring to have an ongoing conversation as my body continues to inevitably change and age.

Who do you need to have a conversation with? (Oops, I asked it again.)

 

(Hospice vigorously protects a patient’s privacy. I’ll take care with how I share my experiences. Any names used are fictitious. Events are combined and/or summarized.)

* The DNR and POLST references are from Nolo – the do-it-yourself legal guide company. There are many places to find information about these forms on the web. Or at a hospice. Or with your doctor. Or . . .

The image at top from Showtime, with apologies to all involved with Modern Family.

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Comments

  1. Larry, thank you for that article. So helpful. I “think” my kids know what I want but I need to really sit down and talk. I do have an advance directive.

    Thank you for your call yesterday, I appreciate it.

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