Having the hard but necessary conversations

These last few months have reminded me of the importance of an advanced directive. I don’t know how many times when I am admitting a patient, I ask if they have an advanced directive or if they would like information about one, and the answer is no.

We are not guaranteed the next breath. We do not know if or when we will be in a position that we cannot verbalize our choices regarding our care. An advanced directive helps guide your family and health care team of your wishes should you not be able to articulate it. It is so hard to watch families argue about what they think their loved one would want to do – be intubated, have CPR, exhaust every medical effort, or simply die comfortably.

I have watched families keeping a loved one “alive” because they can’t say goodbye or someone hasn’t made it to town yet. Or they try to convince their loved one to give chemo one more try and not “give up”, not once thinking about how hard that is physically on their loved one. Or the patient changing their wishes to make it easier on their family despite the pain it will cause them.

My job is to advocate for my patient, even when the family doesn’t like the decision. COVID has shown me how quickly you can go from walking, talking, and being of sound mind, to being intubated and unable to communicate with others.

It is not easy or comfortable to have these conversations but they are necessary. An advanced directive is not set in stone, just like your DNR/DNI status is not set in stone. You can make changes it to. Just have one, please!

PLEASE make sure your loved ones and your health care team know what you would want should you not be able to communicate it.

Do you have an advanced directive?