“Everyone deserves a ‘good death’, the truth and the right to make decisions.”
—Myra Katz
My Thoughts, My Journey, and End-of-Life Care
The Importance of Having an Advance Directive
Many years ago, when I interviewed for a job as a Physician Assistant in an oncology office, the doctor asked me "why” I wanted to work in a difficult field such as oncology. My response was something I had thought about for years. Everybody deserved a "good death," the truth, and the right to make decisions. This went back to my being 16 when my mother died after unsuccessful cardiac surgery to replace her aortic and mitral valves. My last memory of my mother was in the ICU, intubated (with a breathing tube), and more machines than I ever could have imagined hooked up to her. Thus my journey began. She died six hours later without being resuscitated. Nature, and my father, allowed her to die. And for that, I will be forever grateful.
Back in the early '70s, we did not discuss death. My mother died, and that was it. I was a motherless teenager, but nobody talked about it. She died, I returned to school, people whispered around me, and life continued. There was no therapy; everything was just swept under the rug.
Fast forward to Elizabeth Kubler Ross, and death became a "hot topic." We can talk about it now. We can discuss what we want to be done if there is no hope or cure. My years as a PA in oncology included many sleepless nights worrying about my patients and how to talk with them. I was very fortunate as I worked with an oncologist who believed in "hope for the best, expect the worst." When a patient was diagnosed with stage 4 cancer (metastatic with no hope for cure), we talked with them about the journey, about being prepared, and understanding that no matter how hard you "fought," sometimes cancer was bigger than everyone. All we can do is accept it and prepare. Talk with our loved ones, accept comfort care, and hospice care, which helps people live without pain (and be able to control it), talk to our loved ones about dying and choose how and hopefully where and with whom to die.
We still have a long way to go in discussing and dealing with end-of-life care. I hope it happens soon because it is too difficult for the loved ones left behind.
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Advance Directives
"Do you have an Advance Directive?" This question is asked when we go to a hospital, doctor’s office , or have a medical procedure. If the answer is "no," a lengthy form is handed to you, giving you no time to review it or think about it.
So, what is an Advance Directive, and why do we need one?
The actual definition of an Advance Directive is "a written statement of a person's wishes regarding medical treatment, to ensure those wishes are carried out should the person be unable to communicate with the medical provider."
Every state has its own Advance Directive, but typically they are very similar, and frequently states will accept them as written in a different state. The vast majority of Advance Directives have the following information: selecting a health care proxy and treatment preferences.
Many of us do not complete an Advance Directive as there is a misnomer that you cannot do this without an attorney, which is incorrect. All you need is two people to sign the form and witness your signature in most states. The only stipulation is that neither of these witnesses can benefit from your death or be relatives. You may need to get this witnessed in a handful of states, but check your states' laws. You can download this form online and fill it out for the most part. Once the form is completed, you must keep this in a place to be utilized if necessary. Most EMTs (those that typically respond to 911 calls) know to look on the side of the refrigerator or even in the freezer. A copy should be given to all listed on the form and to your doctor and the hospital you typically go to if ill.
Having an Advance Directive means that should you become ill, you will have the treatment you wish. This may include having a feeding tube, being on a ventilator (breathing machine) if you can't breathe on your own (quite common during the Covid pandemic), receiving blood, antibiotics, or even being treated with chemotherapy.
One major benefit of filling out an Advanced Directive is that you are spending time with your loved ones discussing your healthcare and your wishes, something most of us put off as it can be very uncomfortable to talk about. Help them understand what you want and why (and learn what they wish).
There is an organization called "The Conversation Project," I highly recommend reading about this and discussing this with your family and loved ones while you are all healthy. Things can change in a second, and we all need to be prepared.
The majority of us fear illness and death, but it will happen, and we can make it easier on our loved ones if we prepare ahead of time, and signing (and discussing the "what ifs") is an excellent first step.
I can help you with this process. Call or email me for more information. 410-978-3763 or myra@katzadvocate.com