At The End of Her Days

Advanced Directives

        These directives are statements of one's last wishes which include instruction about what to to should the most drastic situation happen. They are similar to Living Wills, but these papers only make wishes known. For wishes to be actually followed, a "Do Not Resuscitate", or DNR order must be in force. Waht follows is an example.

     Every unit has its own culture and legends as well. One I remember from floating to the ICU at my facility was that of a woman who was dying in the unit. Since she was a widow, her children were eventually in agreement to provide comfort measures. The oldest son acted as the group’s spokesperson. As the woman’s condition deteriorated, her sister suddenly appeared. The twist was this: the two had had a falling out about forty years before, and had not spoken to each other since. The children were shocked too, as none had every met her before.

    The sad part of the story comes as the fact that for some reason, the physician treating her agreed to invasive procedures, and other measures to prolong her life. The sister managed this by splitting the children using emotional language when they were already vulnerable. The woman’s condition was such that she made it only a few more days, but at what cause, for what quality?

     This type of incident has remained with me by making me somewhat cynical of advance directives. My experience has been that all they do is state wishes. However, if a caregiver disagrees, it is worthless. Lately, I have been seeing facility to facility standing DNRs. Those orders are the ones carrying weight.  Incidentally, I have cared for a nurse who has DNR tattooed on her chest in three inch letters. Talk about stating your wishes.