End-of-Life Choice, Palliative Care and Counseling

End-of-life planning makes final moments peacefulby Jay

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By Yvonne Baginski
Napa Valley Register
January 11, 2012

For several years, I’ve been teaching the importance of end-of-life planning, with an emphasis on medical care with the new bright-pink forms, the Physician’s Orders for Life-Sustaining Treatment (POLST). I’ve discovered that for many, the term “end-of-life planning” translates to funeral expenses. Few realize, and many find it hard to consider, the possibility that end-of-life planning can also mean how a person might want to live in the last year of life.

The exact moment of death is a mystery to us all. For anyone who’s been around the dying process, though, the indicators are clear. But rarely is anyone brave enough to state clearly and directly to someone who is actually asking how much real time might be left.

If you had 15 days to live, how would your life look?

This last year, I met a man who was admitted to the hospital, knowing he was dying. His end-of-life planning consisted of disposition of most of his personal possessions, and then checking himself into the emergency room for hospital admission. He had no health insurance and a very small savings account. Though he knew he was very ill and dying, he had no idea when.

First, he was admitted to intensive care. He had X-rays, blood draws, IVs, ultrasounds, radium scans. The doctors were trying to figure out why he was going downhill so fast — his organs were failing and they didn’t know why. Tests and more tests were ordered daily.

He asked about transfer to an inpatient hospice. He knew he was dying, and his strong spiritual beliefs dictated a practice in the dying process that could not be honored in the hospital. He wanted to die with a “clear mind,” free of interruptions and distractions. Realizing his physical body was rapidly declining, he fervently wished for spiritual clarity.

Nurses, doctors, chaplains and social workers were his daily visitors. His thoughts were interrupted hourly with questions on his well-being, state of mind, etc. New people came in on every shift change, three times in 24 hours, and even more so on weekends.

Tests and more tests. Treatments, procedures and specialists loomed over him on a daily basis. He asked when he could leave, where he could go, how he could get there, so he could die in peace.

On the 10th day, it was acceded that nothing more could be done. Talk began about discharging him to a local board and care home and bringing in hospice for support.

He was discharged on the 12th day, taken by ambulance to a board and care home, in unfamiliar surroundings, where he knew no one.

He asked for three things: A stereo to play his meditation tapes, his meditation tapes from home, and a monk from his faith at his side to help him through this transition. We got him two out of three.

His daughter and her family arrived the evening of the 14th day. He died the next morning.

Last week, I reviewed his medical bills. In the last 12 days of his life, more than $177,502 was spent on his medical care.

His bill included all types of diagnostic procedures, labs, X-rays, etc. But also sessions of physical therapy and home management therapy. Because he didn’t have health insurance, the hospital gave him a self-pay discount. The rest of the bill was submitted to and paid for by Medi-Cal.

Now, how do you think this whole dying process went for this man?

Except for clearing out his personal possessions, he didn’t plan his dying process at all. Even so, he was steadfast in his pleas to strangers to carry out final wishes which were, frankly, beyond the capability of almost everyone on such short notice.

Unfortunately, what he wanted the most — a serene, peaceful place to die, in the presence of a spiritual mentor — didn’t happen the way he wished.

Instead, he got the best medical care available in Napa County. The effort was to find out what was wrong, so he’d live. Because that’s what our medical system is geared up for — life, not death. But it just so happens that death happens anyway. When we ignore the process of dying, we are erasing the ability to live a quality of life that we might prefer until the moment of death.

Taking personal control is what end-of-life planning is really about. There are many ways to do this, but completing an Advance Directive, having conversations with loved ones, completing a POLST form and clearly writing down wishes are places to start. The Advance Directive and POLST forms are available from the concierge desk at Queen of the Valley Medical Center.

Start the conversation with your family; you might be surprised where it leads.