Absinthe & Cookies (a bit bitter, a bit sweet)

how can I knowledgeably indicate each and every possible treatment I might or might not want should the worst happen?

That's been my excuse for putting off making one too. For example, anything happens right now and YES, of course I want cardiopulmonary resuscitation. On the other hand, if I get to be 90 (ha! ha!), then maybe not. Maybe by then I'll have had enough. So if you make a living will, you've got to keep it updated.

Here's the problem I run into with that part (keeping it updated): What if my mind goes first? I had a dictation tonight on a woman aged 75-80 (can't be too specific thanks to HIPAA)--nothing particularly wrong with her beyond severe Alzheimer's. I mean really severe, to the point she couldn't even describe her symptoms (shortness of breath and near-fainting). Her husband had to sort of interpret for her.

But comes time to order tests and imaging, and the doctor talks first to her daughters. And then it was, "Oh, no, we don't think we want to put mama through a CT scan. She'd just get upset." Well, the doctor wanted a chest CT to rule out pulmonary embolism--blood clot in the lungs, potentially fatal. The doctor didn't actually think a pulmonary embolism was very likely, so the daughters' refusal was not the worst thing in the world.

But then he wanted to do a urinalysis because she had an elevated white count, and AGAIN--"Oh, no, we don't think we'd better put mama through that." What, mama can't pee in a cup or sit still to have a Foley catheter placed? Give me a break.

And the doctor said--and this is word for word, this bit: ". . . and they [the daughters] apparently speak for her, so this [the urinalysis] was not done either."

No one checks for paperwork or orders. They just ask whoever's in the hall who looks like they have the ability to pay for this stuff. I mean, he took the history from the husband, but he asked permission to order tests from the kids.

I get reports like these once a week, at least. Call me paranoid, but I find it terrifying.

That's some of what I'm worried about. and I need to talk to my mum about it all. My father coukdn't make a decision on how to get out of a brown paper bag. Heaven forbid if he had to make decisions for my mum if she were incapaciated.

That's why I'm not sure I'm going to even bother with this living will stuff. As far as I can tell doctors either don't have time or are not inclined to look up a patient's papers, and their relatives aren't either, and gosh, if someone made a mistake and it's too late sure, careers can be ended and people could even end up in trouble with the law, but I'll still be dead.

Not to be cruel, but actually Andrea, you'd still be alive, to what degree is the question. The DNRs and LW are in place to *try* to prevent situations where the quaiity of life would be severely altered and possibly bring about more pain. But, you're right, too many times no one does bother to check to see who's in charge. I had power of attorney with my mother, but one of my brother's was supposed to be responsible for decisions regarding her medical care, he was never around, so all questions went to me even though I was not the one on that paperwork.

Ith - in reference to what you said, the LW should be updated periodically just like any will. As times change, so should your will. Or, you can pay a lawyer to creatively word it for you to cover a vast number of possibilities.

My instructions to my family have been to consult with a Catholic priest as to what constitutes "extraordinary measures" and what constitutes "basic care". I THINK that should account for advances in medicine. Then Lex Communis tells me that Catholic hospitals are removing food and water from advanced Alzheimer's patients. So I am up a creek. The husband and one daughter can't make a decision in a crisis and Amanda is clear that I am living on a heartlung machine long past any hope of recovery because I'm not dying until she is.