Your Last List

Anyone can make long lists of things they don't want to do. On the top of mine you'd find colonoscopies, but after participating in #EOL chats with @DrBeckerSchutte over the past year and the #HCLDR chat from November 26th it's evident that making my wishes for the end of life known is what really stands at the top of the list.

Obviously this is not my stone but it was a surprise and a warning note to see it.

Having worked in a bank for years when I was young I am well versed in starting a conversation about wills and executors. The main reason that resonates with people is that if you don't make your own choices about your money and possessions in a will, the government will step in and take care of it for you. That's not a popular choice.

As for executors, that too can be a delicate problem that can tear families apart.  And yet people take far more care planning the financial issues than they do with their lives.

The quality of life you have at the end of it depends on choices that are made, and who knows better what you want than you yourself. 

My dad set a great example of planning. He made sure that he had done a Power of Attorney for both financial and health decisions for himself and my mom, as well as a will. He also planned his funeral and hers in as much detail as made sense. This was a huge relief when they did die. We could concentrate on family, not the business of funerals.

It was wise of him to do this early. No one could have foreseen my mom's stroke, and her long survival after my dad died.

So this is a call to people who read this to start having discussions about the end of life. 

It will happen to us all.  Studies show 80% prefer to die at home and yet 60% die in a hospital and only 20% die at home.  The figures for survival after CPR are dismal in the elderly - it's really meant for young healthy people.  If you have not chosen to "Allow Natural Death" (AND) or "Do Not Resuscitate" (DNR) you will get the full 'benefits' of modern medical technology even when you would die shortly no matter what is done.

More interesting reading.

How Do Physicians and Non-Physicians Want to Die?

The Other Talk - About talking to adult children about the way you want to live the rest of your life.

The information above is very influenced by the Tweetchats I mentioned, especially a tweet by @ChadCampbell119 when he said "I think including #EOL in basic education like we do with mammograms, colonoscopies etc. Preventative is better. Don't wait till too late."

He also Tweeted this link that discusses what to do with a loved one's online accounts after death. It's very relevant to those with a rich virtual presence.

See the One Slide Project and HealthBlawg for ideas about the questions you should be asking yourself and your loved ones. I jumped into this post with enthusiasm, not really absorbing the years-long tradition of the "Engage With Grace" Project each Thanksgiving. The answers to the "One Slide" will take you a long way towards a decision.

End of Life Choices

My dad had strong opinions about what he wanted at  the end of his life. He told us he was unhappy about the effects of pain pills on his cognition and yet the pain became difficult for him to bear.

He was not in a hospice as he had planned. Though he had applied, there was no space available in hospice, and as his health deteriorated he was admitted to a hospital.  His palliative physician in the hospital was very sensitive and checked on his wishes at every decision point to make sure that he understood the effects of his choices.

I can still see the doctor in my memory, practically kneeling at his bedside in order to be close to him and to communicate better. When he decided to refuse intravenous liquids and nourishment she was there with him to point out the implications of this choice and make sure he knew the result of this decision.

He had a peaceful death that was marred only by the fact that he had contracted MRSA in the hospital and so we all had wear gloves and gowns to see him in his last days.

We were relieved that he was able to make his own decisions even at the end.  It meant a lot to him to be in control in dying as he had been through his whole life.

Dad at Niagara Falls, Maid of the Mist

Based on my reading recently he had a "good death" because he was in control, comfortable, had trust in his care providers and his beliefs and values were honoured.  He knew that the time had come and did not feel there was anything to gain in prolonging his lifespan.

This link is to an article titled How Doctors Die.  It is obvious that more knowledge of healthcare has a huge impact on the choices you make.  I had never before thought seriously about my own wishes but this article helped me to start thinking.