The End of the Journey

We spend our time thinking about how we’re going to live but not necessarily about how we’re going to die. I’m healthy and hopefully a long way from leaving this earth, but recently I’ve had two occasions to contemplate end of life issues. I took a lecture course at UCSD dealing with this concept and I also just spent time with my sister during her recent hospital stay where her doctor brought up the importance of advance directives.

This is a subject that seems to be avoided by many people in our culture. Thinking about death is not a big part of western philosophy. In fact I believe most people avoid that process preferring to ignore the fact that it’s inevitable. In both the lecture course and my sister’s recent experience I was confronted with the fact that we have choices in how we prefer to proceed in various cases. What I learned is that what we see on TV or in movies is not the truest portrayal of facts. We see CPR as being a life saver, but more often than not, that is just not the case.

Only five to 10 percent, at best, are brought back successfully. The rest either do not make it or are left permanently damaged if an EMT does not get to the person within minutes of the incident. In addition many life saving treatments including intubation may save the life, keep the heart beating but leave the patient in a state between life and death, just barely alive.

There are many reasons to consider what you want if heroic measure need to be taken to keep you alive. There are many factors that go into these considerations such as religious beliefs and family input. The important thing is to know what is out there for us. The doctor who spoke with my sister was very candid about the very low success rate for these measures. I was surprised and impressed by his honesty. From him we obtained the newest advance directive document called the Physician Orders for Life Sustaining Treatment (POLST). This is a form filled out by the person and the doctor addressing all the types of interventions and what the person does and does not want.

There is a segment on CPR on medical interventions and a portion on artificially administered nutrition. Each area gives you different options and anything can be changed at any time. The importance of this is that it gives us a say over our own care. Too often these decisions are made just as they are needed and under emotional duress. Sometimes we are not even able to make the decision ourselves.

What I learned from both the lectures and the doctor is the importance of educating ourselves while we are still healthy and making informed decisions knowing that nothing is written in stone. It also gives us and our loved ones some empowerment knowing we have some control when things may not be in control. I remember a talk with my own mother about what she would want and although it was not an easy chat for a daughter to have with an elderly parent, I felt better knowing I had the tools to follow her decisions when the time came. We had all the forms filled out, a Do Not Resuscitate (DNR) posted on her refrigerator and what became a written “contract” between mother and child that would insure a peaceful transition when the time came. I did not feel peace when I lost my mother but I did feel peace knowing she was a participant in how her own journey ended.

Category: Life Style