August News

The thought of actually dying catches most of us by surprise. Yes, we might be able to foresee a future where we no longer exist...but, that's often several hundred years from now. Certainly not in ten, twenty or even maybe one year. There's always unfinished business to take care of, or loved ones who couldn't survive without us...but sometimes, even those of us in the deepest denial, have to admit that there is an end to this endeavor and that somehow, sometime, we will be asking our loved ones to enter into the very profound process of allowing us to go towards the inevitable.

And, I do mean, "allow," because today, medical technology can keep our bodies going for a long time after our spirit is ready to move on to the other side.

Two weeks ago, my dearest friend died. She was just a month short of turning 91 years old, and though her advanced age might seem a normal time to die, her doctors didn't always know about her decision to finally let go. In the last year of her life, she survived five visits to the emergency room, two hospitalizations, a surgery, 30 visits to various doctor's offices and countless hours fretting, fussing and worrying over symptoms, pain, medications and how she was going to manage all the minutae and detail of staying alive a few weeks or months longer.

And, this was a person who said daily, "I'm ready to die."

Except, she couldn't seem to get the message across to the doctors she saw in the emergency room, the hospital, her children, or her caregivers. At some level, no one really believed her because she always went to the doctor's office or the hospital when she needed help, and they did what was needed to make her feel better.

And, she always went along with the offers of help because it gave her hope that maybe this time, she'd revert to feeling like she did back in her 80's.

Then, one day, my friend asked me to help her complete a Physician Order for Life Sustaining Treatment (POLST) form. The POLST is a legal document, signed by a physician, explicitly stating what her preferences are if she was ever hospitalized again. POLST is new to California, and was signed into law just over a year ago. She had formerly completed a Do Not Rescusitate (DNR) form, but discovered that once she was admitted into the emergency room, the DNR form was no longer active in determining the care provided to her while hospitalized. Plus, her heart, though it slowed some, never stopped beating.

She had congestive heart failure, and six months before she died, the doctor put in a pacemaker so that her heartbeat could be normalized. It was the pacemaker placement that finally motivated her to take matters into her own hands. My friend wanted to die a natural death. She wanted to be at peace, at home, and with her beloved children.

In completing the POLST, she made it very clear that she no longer wanted her life to be prolonged by surgeries, contraptions or other heroic measures. On her last hospitalization, she wondered how much treatment to allow, and when the doctors approached her with a needle to remove fluid from her chest, she told them, "No." She was done, and wanted to return home.

On her last visit to the doctor, he suggested open heart surgery. At age 90? She didn't think so, and politely declined. Hospice was ordered and she finally got the comfort of dying the way she had always planned.

My friend died at peace, in her own bed, with her daughter at her side. It was a short four weeks after that final visit to her doctor.

But, I believe, it was the completion of the POLST form that finally gave her the feeling of power of her own life and the way she was going to die. In talking about her own wishes, then discussing them with her children and physicians, she had a very clear vision that she was now in charge. And, it mattered. My friend understood that prolonged suffering was an anguish she didn't want to endure. She had lived a good life, was loved and loved in return and the day before she left this life, was sitting on the couch laughing and advising me to "dump that boyfriend, he's not good enough for you." Just like she always did.

Well, it turned out that I did dump the boyfriend. And, I also think a lot about my friend. Each day I consider her courage, her perseverance and what it took to finally decide that no matter mysterious and fearful it seemed to die, it was a jump she made sooner, rather than later. Completing the POLST was an act of determination and empowerment. And, though it may have seemed that she was at the right age to die, but before she went, she told me that her friend, at the same age, and with exactly the same medical prognosis, has agreed to the open heart surgery.

"It's a matter of choice," she said. And, the truth is, it's a freedom that we all can exercise. The POLST form is an expression of our wishes. No matter what they are. It's the writing down, in a legal form, what we want doctors to do to extend or curtail our life in the process of aging, chronic illness or fraility. The POLST contains each of our personal truth. And, it's an invaluable piece of paper to those who are caring for us through time.

POLST forms are available at doctor's offices, at the concierge desk in the lobby of Queen of the Valley Hospital and, by calling Yvonne Baginski at 226-7127. Baginski also offers presentations to the public on how to complete the POLST.