Living will, advance directive, regular will, etc.

[WildflowerMom]

Talk to me like I’m clueless.    

I need to make a will/document/?? that directs the doctor/hospital what I want done if a certain event happens.    Is this included in your regular will?   I would like my dh to be in charge of my health and carrying out my wishes, does this automatically happen since he is my dh?   What should I include if my biggest concern is stroke, for example?  How detailed do I need to be?   Like, if I can’t breathe on my own, please xyz…. Does anyone know of a ready made form for this stuff?  A checklist would be helpful.   I don’t know what all to include.   Any advice or links are helpful.  Thank you! 

Edited January 27, 2023 by WildflowerMom

[wathe]

Advance Care Planning Canada  website has tons of into and tools.   The workbook is very good.  It's Canadian (obvi), but the principles will be the same.

[Carol in Cal.]

It’s not part of a regular will.

It’s called an advanced directive, and it’s separate.

The law of unintended consequences is relentless, and so it’s a good idea to picture out specific wordings and how they might play out IRL, and to review your advanced directive every couple of years.  

 

[wathe]

Also, it's important to make sure that your substitute decision makers know what your goals of care are.  In a crisis situation where resuscitation is imminent, there isn't time to fetch documents from the lawyer or safety deposit box etc or review documents.  Please make sure that your SDM is empowered to make immediate emergency decisions that are consistent with your wishes.

We do a lot of CPR that we really shouldn't because SDM wasn't prepared to make resusc decisions.  It's extremely traumatic for everyone:  patient, SDM, family, and care team.

Edited January 27, 2023 by wathe

[WildflowerMom]

Just now, Carol in Cal. said:

It’s not part of a regular will.

It’s called an advanced directive, and it’s separate.

The law of unintended consequences is relentless, and so it’s a good idea to picture out specific wordings and how they might play out IRL, and to review your advanced directive every couple of years.  

 

Re: bolded. 
do you mean go through every “what if” I can think of and make sure those are covered?  

[LaughingCat]

It is not one document.  My dad had 3 different docs:

Will -- covers any assets that don't have a beneficiary -- to tell who those assets go to when you die  (note: a lot of financial assets do not go through the will but go to the named beneficiaries -- with a bunch of caveats depending on a particular state's laws)

Medical Power of Attorney -- this is a power of attorney specifically for the situation where the person is not able to make decisions for themselves

Health Care Directive/Living Will -- this covers what you want to happen if you are not able to make decisions -- other than the DNR, I have not seen specific statements of medical decision making though --just stuff like "don't keep me alive if there's no chance I'll come back to myself" type things (not that I've seen very many,

Each of these also is different depending on your state's Laws from my understanding.   

 

[WildflowerMom]

How can I figure out the most likely scenarios and “what ifs”?    I need to do some googling.  Sorry for so many questions.  Just a little overwhelmed thinking of all of it.  

[BlsdMama]

3 minutes ago, WildflowerMom said:

Re: bolded. 
do you mean go through every “what if” I can think of and make sure those are covered?  

For example, my Advanced Directive specifically states DH cannot request lifesaving measures unless recovery is expected.  In our scenario, I have ALS.  No recovery expected and I didn't want him placing a trach against my wishes but if I were to get Covid and need a *temporary* vent, then I wanted that. 

[cjzimmer1]

8 minutes ago, Carol in Cal. said:

It’s not part of a regular will.

It’s called an advanced directive, and it’s separate.

The law of unintended consequences is relentless, and so it’s a good idea to picture out specific wordings and how they might play out IRL, and to review your advanced directive every couple of years.  

 

Yes to the bolded.  My grandmother had something worded along the lines of no life preserving medical interventions (I don't know the exact wording but that was my take on it).  Anyways, the way it was worded meant that even giving oxygen was not in her wishes.  She ended up falling and couldn't make decisions anymore but her medical condition left her her gasping for breath and according to her doctors was basically in a state of feeling like she was being suffocated.  As a family we decided that being suffocated was not what she had in mind when she asked for no medical interventions and overrode that and had her placed on oxygen.  I don't know if it made a difference to her but it definitely made her passing more peaceful for everyone else to be around her.  

[Pawz4me]

16 minutes ago, wathe said:

Also, it's important to make sure that your substitute decision makers know what your goals of care are.  In a crisis situation where resuscitation is imminent, there isn't time to fetch documents from the lawyer or safety deposit box etc or review documents.  Please make sure that your SDM is empowered to make immediate emergency decisions that are consistent with your wishes.

We do a lot of CPR that we really shouldn't because SDM wasn't prepared to make resusc decisions.  It's extremely traumatic for everyone:  patient, SDM, family, and care team.

Having BTDT as a decision maker I feel like the word "extremely" is woefully inadequate. You want someone who can make very, very difficult decisions if the need arises. You also want someone whose mental health can withstand the consequences of having to make those decisions. It's a lot to ask of someone.

 

12 minutes ago, WildflowerMom said:

How can I figure out the most likely scenarios and “what ifs”?    I need to do some googling.  Sorry for so many questions.  Just a little overwhelmed thinking of all of it.  

There may be some good online resources. A good estate planning attorney should be able to help.

Edited January 27, 2023 by Pawz4me

[wathe]

11 minutes ago, WildflowerMom said:

How can I figure out the most likely scenarios and “what ifs”?    I need to do some googling.  Sorry for so many questions.  Just a little overwhelmed thinking of all of it.  

Go through the workbook  from the page I linked in a previous post.

I will argue that it's more important to document your over-arching goals of care.  Once that's known, you SDU and care team can tailor care depending on specific, unique circumstances.  It is , thought, important specifically document interventions that will never be acceptable to you under any circumstances (ie blood products for JW's).

Advanced directives that are too specific often don't actually make medical sense.  

[Harriet Vane]

10 minutes ago, WildflowerMom said:

How can I figure out the most likely scenarios and “what ifs”?    I need to do some googling.  Sorry for so many questions.  Just a little overwhelmed thinking of all of it.  

You will not be able to think of every possible scenario. When you google, think in terms of guiding principles rather than absolutes. 

Which is unhelpfully vague, I know. Because what we all want is not to be brain-dead and lingering in an institution for years, but at the same time we don't want our loved ones to give up on us too soon. That's a very, very difficult balancing act. 

[WildflowerMom]

2 minutes ago, Pawz4me said:

Having BTDT as a decision maker I feel like the word "extremely" is woefully inadequate. You want someone who can make very, very difficult decisions if the need arises. You also want someone whose mental health can withstand the consequences of having to make those decisions. It's a lot to ask of someone.

 

There may be some good online resources. A good estate planning attorney should be able to help.

Just wondering “aloud”, but other than dh, who does that leave?   I mean, i worry my mother would not make the hard decisions.  And I’d hate to leave my kid with any guilt.   I need to think on that a while.   

[LaughingCat]

Five Wishes is a health care directive that our church did a session on.  It is supposedly valid in almost all states (not New Hampshire, Kansas, Ohio, or Texas apparently)

My dad lived in WA state and he had a 1 page standard health care directive up on the fridge -- my brother said the ambulance techs would ask for it by name the times they had to come (but I just did a quick google and didn't find it -- so maybe it was for his particular county)

[WildflowerMom]

1 minute ago, wathe said:

Go through the workbook  from the page I linked in a previous post.

I will argue that it's more important to document your over-arching goals of care.  Once that's known, you SDU and care team can tailor care depending on specific, unique circumstances.  It is , thought, important specifically document interventions that will never be acceptable to you under any circumstances (ie blood products for JW's).

Advanced directives that are too specific often don't actually make medical sense.  

I’ve already printed it out. 💛 I’m on the ball today.   I plan to go over it with dh this weekend when the timing is right. 

[wathe]

8 minutes ago, cjzimmer1 said:

As a family we decided that being suffocated was not what she had in mind when she asked for no medical interventions and overrode that and had her placed on oxygen. 

This is very common.  SDU's override AD's, so long as it is clear that they are making decisions based on what they feel the pt would have wanted in the specific circumstances that actually happen.

[Carol in Cal.]

20 minutes ago, WildflowerMom said:

Re: bolded. 
do you mean go through every “what if” I can think of and make sure those are covered?  

More so to think of the what ifs that have arisen newly since you did it.

For instance, I have a relative who had a DNR clause that was so strong that it prevented her from getting TPA to treat a stroke, because she was unconscious.  When she wrote the DNR, TPA treatments were not available.  The lack of the TPA meant that when she came to, which was unexpected, the damage was severe and she could never live independently again and also went blind.  Whereas with TPA it’s pretty common to exit the incident just about as good as new.

[wathe]

10 minutes ago, Pawz4me said:

Having BTDT as a decision maker I feel like the word "extremely" is woefully inadequate. You want someone who can make very, very difficult decisions if the need arises. You also want someone whose mental health can withstand the consequences of having to make those decisions. It's a lot to ask of someone.

 

 

Agreed.  Traumatic, futile CPR and the emotional tension between HCW and unprepared SDU's is a significant contributor to HCW burnout and PTSD.

 

ETA:  of course it's terrible for families too.  For HCW, it happens over and over and over and over ---  cumulative trauma.

Edited January 27, 2023 by wathe

[LaughingCat]

4 minutes ago, Carol in Cal. said:

More so to think of the what ifs that have arisen newly since you did it.

For instance, I have a relative who had a DNR clause that was so strong that it prevented her from getting TPA to treat a stroke, because she was unconscious.  When she wrote the DNR, TPA treatments were not available.  The lack of the TPA meant that when she came to, which was unexpected, the damage was severe and she could never live independently again and also went blind.  Whereas with TPA it’s pretty common to exit the incident just about as good as new.

That's very interesting - because I've heard multiple places that one should include a DNR (when beyond a certain point of fragility due to age or illness) because of the trauma that treating cardiac arrest causes (that multiple people have also brought up on this thread).  I did not realize the DNR meant that other non traumatic treatments could not take place. 

[Mrs Tiggywinkle Again]

5 minutes ago, wathe said:

Agreed.  Traumatic, futile CPR and the emotional tension between HCW and unprepared SDU's is a significant contributor to HCW burnout and PTSD.

When people ask “what’s your worst call/memory/etc”(truly terrible thing to ask a HCW) it’s not the gruesome car accidents they’re thinking.

Its the 90 year old I did CPR and ran down the full ACLS algorithm on because she had no advanced wishes written down and her husband and son wanted EVERYTHING possible done when she died suddenly. 

My wishes are if there’s minimal hope for neurological recovery, nothing is to be done. If an aneurysm in my brain bursts, just let me go in peace. I trust DH to make the right decisions, but not my mom, who seems to believe in extreme measures no matter what(to the point my dad, an EMT of 45 years, has my husband legally designated his decision maker and has several documents from his lawyer saying that). My sister, a former paramedic, is my alternate decision maker if DH is gone or incapacitated.

 

[Corraleno]

I have a will, a financial POA, a medical POA, and a POLST document (Portable Orders for Life-Sustaining Treatment).

The POLST is kind of a fill in the blank form, that you can say yes or no to each option, but each direction starts with the idea that doctors have determined the prognosis for recovery is very low. Some of the choices are things like intubation, CPR, feeding tube, etc.

You also need a separate medical POA that allows someone else to make decisions in the event you are unconscious or not mentally competent to make decisions for yourself, but where recovery is likely. 

So, for example, my POLST says no CPR, intubation, feeding tube, etc., if I'm unlikely to recover, but DS (my medical POA) knows that I do want those things if there is a reasonable chance of recovery.

You should also have a financial POA, and all the docs should list a secondary person if your DH is also incapacitated. The documents won't do you any good if the person with POA for you is in the same accident and also unconscious. 

[Mrs Tiggywinkle Again]

3 minutes ago, LaughingCat said:

That's very interesting - because I've heard multiple places that one should include a DNR (when beyond a certain point of fragility due to age or illness) because of the trauma that treating cardiac arrest causes (that multiple people have also brought up on this thread).  I did not realize the DNR meant that other non traumatic treatments could not take place. 

It depends on the wording and the state. New York has a MOLST form where you can choose to have no treatments done for anything but to relieve pain, not even antibiotics, and do not send to the hospital for anything(that would apply to home care or a nursing home).  You can check no IV fluids, comfort IV fluids, and there’s a box for dialysis decisions.  I like it because it’s very explicit yet simple to understand.

https://www.health.ny.gov/forms/doh-5003.pdf

[Carol in Cal.]

12 minutes ago, LaughingCat said:

That's very interesting - because I've heard multiple places that one should include a DNR (when beyond a certain point of fragility due to age or illness) because of the trauma that treating cardiac arrest causes (that multiple people have also brought up on this thread).  I did not realize the DNR meant that other non traumatic treatments could not take place. 

I don’t know a lot of the details of this, but that was how the process was described to me—the the Do Not Resusitate order was written more strongly than usual, and prevented this treatment inadvertently.  I don’t know whether that is common or not, but it made me realize how important it could be to discuss possibilities with someone knowledgeable every so often just in case.  In this particular case, her grown son MPOA wanted to have TPA administered but the doctors felt that they could not do so given the wording of the DNR.

Edited January 27, 2023 by Carol in Cal.

[Pawz4me]

1 minute ago, Mrs Tiggywinkle Again said:

My wishes are if there’s minimal hope for neurological recovery, nothing is to be done. If an aneurysm in my brain bursts, just let me go in peace. I trust DH to make the right decisions, but not my mom, who seems to believe in extreme measures no matter what(to the point my dad, an EMT of 45 years, has my husband legally designated his decision maker and has several documents from his lawyer saying that). My sister, a former paramedic, is my alternate decision maker if DH is gone or incapacitated.

 

The flip side of that is that my brother has been an EMT for almost 40 years. When the decisions had to be made for our mother--both the DNR order and then eventually a terminal wean--I'm the one who had to do it. Both times. He just could not. Yes, I know having to perform CPR on older or frailer people is horrible for medical providers. And I feel for them and wish more people were better educated about that. But having to make life ending decisions for a loved one is horrible in an entirely different way and some people simply cannot do it, even when they're well aware of the person's wishes. I'm glad I could make those decisions, and I'm glad he didn't have to. But I can't say it didn't come without a high cost to my mental health. It definitely gave me a whole new perspective on who I want for my decision maker if DH is no longer here to do it. I think I would skip over my brother and my boys and go to my sister-in-law. Yes, it would be tough on her. But I know she could do it.

[WildflowerMom]

I'm going to drop out of the convo a minute and take a breather.  I'm sure I'll have more questions after while. Sorry

[Mrs Tiggywinkle Again]

2 minutes ago, Pawz4me said:

The flip side of that is that my brother has been an EMT for almost 40 years. When the decisions had to be made for our mother--both the DNR order and then eventually a terminal wean--I'm the one who had to do it. Both times. He just could not. Yes, I know having to perform CPR on older or frailer people is horrible for medical providers. And I feel for them and wish more people were better educated about that. But having to make life ending decisions for a loved one is horrible in an entirely different way and some people simply cannot do it, even when they're well aware of the person's wishes. I'm glad I could make those decisions, and I'm glad he didn't have to. But I can't say it didn't come without a high cost to my mental health. It definitely gave me a whole new perspective on who I want for my decision maker if DH is no longer here to do it. I think I would skip over my brother and my boys and go to my sister-in-law. Yes, it would be tough on her. But I know she could do it.

Just out of curiosity, do you think if she’d had written down the instructions and end of life wishes or discussed them at length it would have been easier? I feel like that’s such a difficult and hard decision for anyone to have to make for another person, but I am wondering if really explicit instructions would make someone feel like they were just following the person’s decisions.

I ask because I truly want nothing done, even before it gets to the point of cardiac arrest. I do not want dialysis or feeding tubes or, if truly incapacitated, even antibiotics. Yet I also don’t want my family(thinking adult children down the road) struggling with that.  I am just thinking that as it is already all written out explicitly, maybe that would reduce some of their mental load.

Just musing out loud.

[wathe]

"DNR" can mean different things.  One must specify some details.

My hospital had a lovely tool that divided resusc decisions into 4 broad categories:

• Full resus.  Do everything.
• Limited resus.  NO CPR, but would accept bipap, pressors, cardioversion, ICU level care. (Do everything except CPR)
• DNR supportive.  No CPR, no pressers, no ICU.  But yes to antbiotics, IV fluids, and other non-ICU interventions to reverse reversible causes and extend life
• DNR comfort care.  End of life care.  No CPR.  Comfort measures/symptom management only.   No antiobiotics, blood work, IV's, or other interventions meant to reverse reversable causes or extend life.

It was very helpful for walking SDU's through goals of care.  

(These categories are not fixed in stone; interventions would be tailored to the unique circumstances of each pt, but medical interventions tend to be a package deal and SDU's sometimes want to choose a la carte in ways that do not make medical sense - having broad categories helps guide decisions.)

We got rid of it because it was not supported by the almighty new EMR.  What we have now is much worse. I am mad about it.

 

 

[Carol in Cal.]

I do think it is important to recognize that often antibiotics ARE comfort care, particularly in the case of a UTI or kidney infection, both of which are chronically quite painful.  And maybe in the case of some lung infections which can be painful and/or suffocating, both of which are very uncomfortable.

[Laura Corin]

49 minutes ago, WildflowerMom said:

How can I figure out the most likely scenarios and “what ifs”?    I need to do some googling.  Sorry for so many questions.  Just a little overwhelmed thinking of all of it.  

I used a form from Compassion in Dying as a guide https://compassionindying.org.uk/choose-a-way-to-make-an-advance-decision-living-will/

[livetoread]

My then 96 yo mil with dementia had to have a simple surgery. My sil has medical POA. MIL, back when she was lucid, was pretty anti medical intervention and she has a DNR. MIL did not pass any of the tests they asked her before surgery to test lucidity (and no one has official guardianship since MIL is fine with everyone taking over), so SIL was up to bat. In front of everyone, including MIL, they asked if she had a heart episode on the table, would she want to be resuscitated. MIL pipes up, "Yes" and so SIL agreed. I was sick to my stomach. I was tempted to ask the doc to just go through what it would entail but I'm an in law and in that family, it wouldn't have been appreciated. BIL, a physician himself, also squirmed but kept his mouth shut.

Personally I think going under anesthesia and never waking up when you are 96 with dementia is about the best death one could hope for. Luckily she came through with flying colors, but I can't imagine the trauma we all would have had to endure if not. I understand how hard it would have been for SIL to pull the doc aside and say, "Um actually, no" especially after MIL said yes but what a nightmare. I'm pretty hardcore and if it had been my mom I know I would have done it. Mom says she would haunt me if I didn't, lol. 

[gardenmom5]

There are forms for advance directives.

 . . . The hospital we used with my mother, required a new one. every. single. time. she was admitted.

It was actually good to have it on file there anyway, because when my brother was causing trouble - the fact she had one on file meant they wouldn't listen to him, and called me.

[rebcoola]

1 hour ago, Pawz4me said:

Having BTDT as a decision maker I feel like the word "extremely" is woefully inadequate. You want someone who can make very, very difficult decisions if the need arises. You also want someone whose mental health can withstand the consequences of having to make those decisions. It's a lot to ask of someone.

 

 

  

1 hour ago, WildflowerMom said:

Just wondering “aloud”, but other than dh, who does that leave?   I mean, i worry my mother would not make the hard decisions.  And I’d hate to leave my kid with any guilt.   I need to think on that a while.   

This is so hard to decide who is that person sometimes.  My siblings and I were all around for my grandma's final days and slightly involved in the dynamics of her having a DNR that wasn't super clear in these circumstances.  Things were my moms decision and I believe she following the intentions of my grandmother very well. Her sister wanted everything done and well it wasn't always pretty.  

 

A few months after everything settled down my mom came and gave me copies of her POA and DNR and we talked.  I am the youngest and in some ways the least obvious choice but she had watched how we actually reacted and thought I handled things the best. Yes it is me even over my dad he just can't make fast enough decisions.

If possible I would try and reflect on who really handles crisis well.

[Pawz4me]

1 hour ago, Mrs Tiggywinkle Again said:

Just out of curiosity, do you think if she’d had written down the instructions and end of life wishes or discussed them at length it would have been easier? I feel like that’s such a difficult and hard decision for anyone to have to make for another person, but I am wondering if really explicit instructions would make someone feel like they were just following the person’s decisions.

 

She had discussed her wishes with both of us at length, that's why I was able to make the very hard decisions. I knew it was what she would have wanted because she'd consistently said so over and over for years. And I know she had the same conversations with him, I was present for some of them. It wasn't that we disagreed at all--we both knew what she wanted and what we had to do. He just couldn't be the one to do it. The real thing is so very far removed from sitting around the kitchen table talking about theoretical what ifs. Now if I hadn't been there I feel sure he would have done it. If I had wobbled I'm sure we would have shored each other up and got through it somehow. It's just so much harder in reality than in theory.

[QueenCat]

2 hours ago, WildflowerMom said:

Re: bolded. 
do you mean go through every “what if” I can think of and make sure those are covered?  

You don't really  have to think of all of them. There will be a checklist and questions to answer that will cover it all when you are filling out the forms to create your Living Will/Advance Directive. 

[73349]

I just want to make sure you know that a will is not in force until you are dead according to the state. It cannot be used for anything medical. It also cannot designate who has power of attorney, custody of minors, or anything else until you are legally identified as deceased.

[WildflowerMom]

2 hours ago, gardenmom5 said:

There are forms for advance directives.

 . . . The hospital we used with my mother, required a new one. every. single. time. she was admitted.

It was actually good to have it on file there anyway, because when my brother was causing trouble - the fact she had one on file meant they wouldn't listen to him, and called me.

Re: bolded.   How does that work if you're admitted in midst of a massive stroke?   Do you mean that every time she was discharged, she'd have to write a new one for next time?

[Beth S]

2 hours ago, gardenmom5 said:

There are forms for advance directives.

 . . . The hospital we used with my mother, required a new one. every. single. time. she was admitted.

It was actually good to have it on file there anyway, because when my brother was causing trouble - the fact she had one on file meant they wouldn't listen to him, and called me.

Our local hospital now has online accounts for everyone.  I posted my living will/advanced directive documents there.  I was asked about them last week (pre-colonoscopy) & it was simple b/c they could access the documents in My Chart.

[WildflowerMom]

1 hour ago, rebcoola said:

  

This is so hard to decide who is that person sometimes.  My siblings and I were all around for my grandma's final days and slightly involved in the dynamics of her having a DNR that wasn't super clear in these circumstances.  Things were my moms decision and I believe she following the intentions of my grandmother very well. Her sister wanted everything done and well it wasn't always pretty.  

 

A few months after everything settled down my mom came and gave me copies of her POA and DNR and we talked.  I am the youngest and in some ways the least obvious choice but she had watched how we actually reacted and thought I handled things the best. Yes it is me even over my dad he just can't make fast enough decisions.

If possible I would try and reflect on who really handles crisis well.

I've been thinking, and I think I'll ask my sister in law.  She lives states away though, but surely they could call and talk to her until she could get a flight down here. 

[Pawz4me]

2 hours ago, gardenmom5 said:

 . . . The hospital we used with my mother, required a new one. every. single. time. she was admitted

That wouldn’t be legal in my state. A hospital can certainly make patients believe they have to fill out one of the hospital’s own forms every single admission, but they couldn’t refuse to honor a legally executed advance directive or HCPOA. 

[Faith-manor]

3 hours ago, Mrs Tiggywinkle Again said:

 

My wishes are if there’s minimal hope for neurological recovery, nothing is to be done. If an aneurysm in my brain bursts, just let me go in peace. I trust DH to make the right decisions, but not my mom, who seems to believe in extreme measures no matter what(to the point my dad, an EMT of 45 years, has my husband legally designated his decision maker and has several documents from his lawyer saying that). My sister, a former paramedic, is my alternate decision maker if DH is gone or incapacitated.

 

I agree with this. My mother and sister are the kind of people who simply cannot let go. They will take every conceivable, fruitless, trauma inducing measure possible even when doctors and nurses are pleading them to rethink it,  and as a result, my terminally ill father -who put them in charge of decision making - suffered unimaginably despite the fact there was ZERO hope of recovery. It was gruesome to watch. It convinced me that not only should those two NEVER be in charge of making medical decisions for others, that I would put my former paramedic daughter and my hyper rational next eldest child in that position should something happen to Mark, and I have informed my sister and mother that they may be barred from being near if they cannot be trusted to leave the decisions makers in peace. The drama was literally mind boggling.

[GoVanGogh]

6 hours ago, BlsdMama said:

For example, my Advanced Directive specifically states DH cannot request lifesaving measures unless recovery is expected.  In our scenario, I have ALS.  No recovery expected and I didn't want him placing a trach against my wishes but if I were to get Covid and need a *temporary* vent, then I wanted that. 

I have Parkinson’s and did similar. 
 

I have not yet read the book, but Being Mortal by Atul Gawande was recommended to me. 
 

As far as who to ask to be the decision maker, know that it can change. My cousin had been on my DH and mine, but we changed it after my aunt passed away. My cousin was struggling with decisions she had to make regarding her mom and we didn’t feel she could handle going through that again. In the meantime, my SIL matured well and settled down and moved near us, so we talked with her about being on our legal documents. 

[WildflowerMom]

 Being Mortal is an excellent book.   
 

I've been on YouTube this evening looking at some procedures.    I've learned some things.  For ex I thought intubation meant they cut through the throat.   I didn't realize that was a trache.    Trying to make wise decisions.    I may end up living forever (well, you know what I mean), but chances are higher for some things and I'm already having the symptoms so I want to be ready, ykwim?    Thanks for all the help and advice.   
 

I did look on my local hospital's website for an advance directive form and such and found nothing.   A friend pm'd me something specifically for Georgia so I'm going to look at that.   I was a little surprised the hospital didn't have anything.   

[gardenmom5]

3 hours ago, WildflowerMom said:

Re: bolded.   How does that work if you're admitted in midst of a massive stroke?   Do you mean that every time she was discharged, she'd have to write a new one for next time?

No, when she was admitted. 

It was on file, so when my brother dragged her in, they refused to do what he wanted and called me.

When she was brought in unconscious,  they referred to it.

[wathe]

8 hours ago, WildflowerMom said:

Re: bolded.   How does that work if you're admitted in midst of a massive stroke?   Do you mean that every time she was discharged, she'd have to write a new one for next time?

Resuscitation/code status has to be re-ordered by MD with each new admission - the orders (just like orders for meds or anything else) do not carry. over from one admission to the next.  The history of resusc orders from past admissions is available in the EMR, but they are not active until re-ordered.

As for what happens when pts who can't speak for themselves arrive in ED requiring resuscitation with no SDU immediately available:  The ED MD has to make the decision in the moment (and take responsibility for it)

Sometimes patients come with clear, formal DNR orders (my province has a DNR confirmation form especially meant to direct EMS and fire; ED MDs also use them to to make resusc decisions. Pt's are instructed to leave them on the fridge.)  Sometimes it's very clear in the EMR of a recent past visit that the pt has a terminal diagnosis and that the plan is strictly palliative.  Sometimes it's clear that resusc is futile.  

Otherwise, though, ED MD's are going to err on the side of resuscitation.

 

[livetoread]

14 hours ago, WildflowerMom said:

Trying to make wise decisions.    I may end up living forever (well, you know what I mean), but chances are higher for some things and I'm already having the symptoms so I want to be ready, ykwim?

Sounds scary, and I'm really sorry you are having to plan for such things. Hugs to you as you navigate this.