A few weeks ago, I spoke at the 21st Annual Aging Well Conference in Evanston, Illinois. I talked about the most common diagnoses of the elderly admitted to the Intensive Care Unit (ICU), the various life-sustaining technologies we use to support our sick senior patients and how to speak for yourself in those moments when you are unable.

For instance, did you know the most common technological support in the ICU is mechanical ventilation, with 20-30% of U.S. ICU admissions requiring this type of intervention? And did you know that you cannot talk when you are on a ventilator?

Imagine being in a hospital room, hooked up to a heart monitor, IVs and a tube in your throat helping you breathe and being unable to talk to your family or to your medical team. You might be able to nod your head “yes” or “no” to simple questions, or even mouth a few words (“water” is a frequent request from patients on a breathing machine), that is, if you are awake and not sedated.

The point is, when you are hospitalized and unable to speak, for whatever reason, you cannot tell anyone what you want or don’t want to happen with your body. You might even be completely unaware of what is happening to your body. And if you have preferences about your care, you really won’t be able to tell us when you are unable to speak.

Your family will have to guess what you would want. Or they might choose to do what they would want for themselves. Or they might be paralyzed with fear and afraid of making a “wrong” choice and therefore not make any decisions at all.

This is why I want to help you complete your advanced directives. Even if the time you are unable to speak is brief, your power of attorney for healthcare will know your preferences and advocate for the choices that align with your wishes, until you are able to speak again for yourself.

What do you say? And what do you say when you can’t say?

“Not being able to speak is not the same as not having anything to say.”
– Rosemary Crossely

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