August is make your will month

[Farrar]

Apparently August is national make your will/advanced directive/estate planning month. So that's a good reminder to all of us.

I feel like adding to this that planning for bad things does not make bad things happen. That's something that most of us would scoff at on its face, but I'm telling you, in the thick of illness and disaster, a lot of people get very superstitious about it. And then because they're superstitious, they refuse to make plans about death. And then they die, because that happens sometimes. And that leaves their loved ones scrambling because no one knows who was supposed to get the heirloom hutch, who should take care of the dog, who should be in charge of the money, what music they wanted at the funeral, or even if they wanted to be cremated or buried or what. But that's all the more reason not to wait until you've been diagnosed with stage 4 cancer or are fighting for your life after a car accident or something to make your will. There's a strong chance you'll also get superstitious at that point. Do it when you're clear-headed and well.

[Spryte]

Good reminder.

It’s a good time to review existing plans and make any needed changes, too!

[wathe]

16 minutes ago, Farrar said:

Apparently August is national make your will/advanced directive/estate planning month. So that's a good reminder to all of us.

I feel like adding to this that planning for bad things does not make bad things happen. That's something that most of us would scoff at on its face, but I'm telling you, in the thick of illness and disaster, a lot of people get very superstitious about it. And then because they're superstitious, they refuse to make plans about death. And then they die, because that happens sometimes. And that leaves their loved ones scrambling because no one knows who was supposed to get the heirloom hutch, who should take care of the dog, who should be in charge of the money, what music they wanted at the funeral, or even if they wanted to be cremated or buried or what. But that's all the more reason not to wait until you've been diagnosed with stage 4 cancer or are fighting for your life after a car accident or something to make your will. There's a strong chance you'll also get superstitious at that point. Do it when you're clear-headed and well.

Yes, yes, yes.  Especially advanced directives, specifically resuscitation directives.  Especially, especially in the thick of illness.  Especially, especially,  especially in the thick of illness that has a poor prognosis.  There is nothing more stressful for families than having to make resuscitation decisions in a moment of crisis, because very  ill loved-one wouldn't/didn't want to talk about it while still capable.  It leads to much futile, violent CPR and other horribly invasive resusc procedures, that are traumatizing for the pt, the family and the health care team.  

[SKL]

Last week, when I went for my colonoscopy, they kept asking me if I have a living will.  I said I think so, I don't remember what it says (we did all that a few years ago).  They said they want a copy of it if I have one.

Well aside from the fact that I didn't intend to die from a colonoscopy ... I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

[Grace Hopper]

Thanks for the reminder! August here is send your kid to college month, but I’ll make September our review documents month. 

[wathe]

30 minutes ago, SKL said:

Last week, when I went for my colonoscopy, they kept asking me if I have a living will.  I said I think so, I don't remember what it says (we did all that a few years ago).  They said they want a copy of it if I have one.

Well aside from the fact that I didn't intend to die from a colonoscopy ... I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

No, most people don't carry them around.  But, you really should know the gist of what's in it and be able to communicate that to you health care team.  Anesthetic is low risk for most people, but still risky enough that the team needs to know what your directives are should something go wrong and you can't speak for yourself, and who makes decisions on your behalf (ie POA).  For a colonscopy with sedation, they at least need to know if you are full code (full resuscitation), DNR (no resuscitation) or something in between.

Also, electronic EMRs and pre-op check-lists force the team to ask certain questions of everyone, even when they may not seem relevant to your particular situation.  EMRs, standardization of medicine, and medical-record bloat are a whole 'nother thing that affect EVERYTHING, let me tell you.

[cbollin]

45 minutes ago, SKL said:

Last week, when I went for my colonoscopy, they kept asking me if I have a living will.  I said I think so, I don't remember what it says (we did all that a few years ago).  They said they want a copy of it if I have one.

Well aside from the fact that I didn't intend to die from a colonoscopy ... I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

 

I have that same procedure in a few weeks and all the same questions. ooh..  maybe I should look online at my local library for templates.  There's a section of legal forms.... could drop off the papers before procedure.  not a bad idea.  I mean in their office policies it says they'll do CPR which is what I want so... 

just thinking out loud.  if I had one, it would be in the system.  I wouldn't carry it with me for most time, but doing all that paperwork, sure..  then the hospital would have it.  hmmm..

to OP: thanks for the august reminder to get this done.  appreciate it

[Moose]

On 8/17/2022 at 9:23 AM, Farrar said:

I feel like adding to this that planning for bad things does not make bad things happen. That's something that most of us would scoff at on its face, but I'm telling you, in the thick of illness and disaster, a lot of people get very superstitious about it. And then because they're superstitious, they refuse to make plans about death.

This was exactly my SIL. She passed away last month, rather unexpectedly. She'd been battling cancer for 2 year and then caught covid.  Her husband tried asking her once what she would want if things took a turn, but she said she didn't want to talk about it. She was only 47 years old and because she made no plans, her husband and two kids made a lot of big decisions in a state of grief. Its been a lot on the whole family. 

Edited August 18, 2022 by Moose

[KSera]

1 hour ago, SKL said:

I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

We have a card we carry in our wallet. It has some kind of phone number on it that can be called and our documents would be provided. I don’t remember how that works as far as privacy stuff goes; I’m assuming they only provide them to places that they know would be authorized to have them.

[Pawz4me]

1 hour ago, SKL said:

 

Well aside from the fact that I didn't intend to die from a colonoscopy ... I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

When DH was doing some of the pre-op stuff before his cancer surgery he was asked about it. And they asked him to bring it on his surgery date. We did, and they made a copy of it. So yes, the health/hospital system we use the most has a copy of his.

[SKL]

1 hour ago, wathe said:

No, most people don't carry them around.  But, you really should know the gist of what's in it and be able to communicate that to you health care team.  Anesthetic is low risk for most people, but still risky enough that the team needs to know what your directives are should something go wrong and you can't speak for yourself, and who makes decisions on your behalf (ie POA).  For a colonscopy with sedation, they at least need to know if you are full code (full resuscitation), DNR (no resuscitation) or something in between.

Also, electronic EMRs and pre-op check-lists force the team to ask certain questions of everyone, even when they may not seem relevant to your particular situation.  EMRs, standardization of medicine, and medical-record bloat are a whole 'nother thing that affect EVERYTHING, let me tell you.

Well, I did tell them I have two 15yo kids who have no other parent, so I need to be kept alive if at all possible.

I think my legal documents say no extraordinary measures if I'm brain dead.  I think it defines what "extraordinary" means.  Honestly, I couldn't think clearly right before the procedure.  I was irrationally nervous and not chemically normal due to the diet/fast.

Just the fact of them talking about living wills before a colonoscopy threw me off guard.  Like what??

But it's a good point - we should know how to articulate what we want in unexpected situations.  I guess it's not enough to make a will; we need to review all that stuff from time to time.

[wathe]

10 minutes ago, SKL said:

Well, I did tell them I have two 15yo kids who have no other parent, so I need to be kept alive if at all possible.

I think my legal documents say no extraordinary measures if I'm brain dead.  I think it defines what "extraordinary" means.  Honestly, I couldn't think clearly right before the procedure.  I was irrationally nervous and not chemically normal due to the diet/fast.

Just the fact of them talking about living wills before a colonoscopy threw me off guard.  Like what??

But it's a good point - we should know how to articulate what we want in unexpected situations.  I guess it's not enough to make a will; we need to review all that stuff from time to time.

And really, that's enough.  Provider ticks Full Code or Full Resuscitation or whatever equivalent tick box needs to the ticked in the EMR.  That's enough guidance to manage unexpected intra-op or immediate post-op badness. The rest would get sorted out later, in consultation with one's substitute decision maker (SDM) anyway.  There is no health care system that I'm aware of that just does whatever the AD says.  It's usually used as more of a guide for SDM decision making - 'cause there's always nuance that AD's can't address .  And SDM can over-ride AD,  so long as everyone believes SDM is doing their best to respect what they think the patient would actually want in any given scenario.

[Ottakee]

@wathe I appreciate your insight.   My Dr friend suggests the book Being Mortal as a great way to start thinking and talking about end of life things.  There is a huge difference in the ICU of saving a life va just prolonging death.   
 

I-have a trust set up for my kids and my living will, etc.  I should call and set up an appointment to update some things though.

[wathe]

8 minutes ago, Ottakee said:

@wathe I appreciate your insight.   My Dr friend suggests the book Being Mortal as a great way to start thinking and talking about end of life things.  There is a huge difference in the ICU of saving a life va just prolonging death.   
 

I-have a trust set up for my kids and my living will, etc.  I should call and set up an appointment to update some things though.

I would like to see stacks and stacks of free copies of Being Mortal in every hospital and clinic waiting room.  It a fabulous book.

He has another great book about checklists, particularly with respect to surgical procedures The Checklist Manifesto  and a fabulous article in the New Yorker on EMRs Why Doctors Hate Their Computers

Edited August 17, 2022 by wathe

[Laura Corin]

3 hours ago, SKL said:

Last week, when I went for my colonoscopy, they kept asking me if I have a living will.  I said I think so, I don't remember what it says (we did all that a few years ago).  They said they want a copy of it if I have one.

Well aside from the fact that I didn't intend to die from a colonoscopy ... I guess that makes sense, but who carries those around with them?  Do you all provide a copy to your health system just in case?

My mother lodged a copy with her doctor,  who witnessed it. We have a copy, as has her care home. When I broached the subject a few years ago, she was very happy to make one. The last thing she wants is heroic medicine at this stage. She has also chosen not to be resuscitated, and I carry a copy of that single page.

Edited August 17, 2022 by Laura Corin