The three girls are gathered around his bed, each handling the situation as best they can.  Dad has been in and out of the hospital 4 times within the last 18 months.  The hospital stays are usually related to his chronic obstructive pulmonary disease (COPD) with bouts of pneumonia or heart failure complicating his breathing.  But this time is different; he hasn’t bounced back the way he normally did and his condition was so critical that he needed a ventilator to support his breathing.  Now they just learned he had a heart attack and his heart function is severely reduced.  The hospital team met with the family to talk about their dad’s wishes and advanced directives.

The team told them about his current condition and treatment; he is critical and has medications going through the IV continuously to keep his blood pressure up in a normal range because it is too low without it and he is on a second medication to help his heart to pump.  He is sedated because he is very unstable when he is awake and uses up too much oxygen fighting against the breathing machine. He has an IV in his neck and his hands are restrained so he won’t pull out the tubes and wires.  And he can’t speak to his girls because of the tube in his throat.  The girls wonder if he can even hear them when they talk to him.

Mom always made decisions with Dad when she was still alive.  Dad didn’t want to talk about his wishes for situations like this because he didn’t want to burden his daughters.  There never seemed to be a “good time” to talk about it and none of them wanted to push him.  He could get a bit cranky when it came to talking about his health.

Since his wife had already passed away and there weren’t any official advance directive documents in place, the medical decisions fell to the daughters. Their first decision was regarding CPR.  They heard a lot of information in medical talk that was complex involving irregular heartbeats and defibrillators and pacemakers and chest compressions…their heads were spinning.  They needed a little time to sort out what they heard.

Each of the daughters thought they heard something that the other two didn’t.  One thought it sounded like a good idea to do everything they could and one thought it sounded like that would be too much at his age with his failing heart and lungs.  The third daughter thought the team was saying it could go either way and it was up to them to decide.   Now they wished they had pushed their dad to tell them what he would have wanted.  None of them felt comfortable with the decisions they had to make after hearing from the medical team and none of them were completely clear on everything the medical team said.

If only they had some guidance from their dad.  What would he have said?  If he were sitting with us right now around his bed, what would he think of all this?  They felt so uncertain about making the “right” decisions and couldn’t believe how bad his condition was because he had always managed to pull through.  What if they stopped things too soon?

This type of scenario often happens to people with serious illness.  As their health declines, their “new normal” declines.  It is hard to come to terms with the decisions that will have to be made at some point.  And if no one is talking about it, no one is prepared to make those decisions confidently.  It truly makes a difference to be able to say “My Dad said he would not want that.”  Or “My wife wrote it right here, if she was ever in this condition, this is what she would want.”

To be the person given that authority and to step in, given the information from the medical team to help guide you toward the best decision, that is advocating for your loved one.  That is honoring the person they are and speaking for them when they cannot. Advance directives are so important to talk about now, when you can talk about it, when you can ask questions, when you can make a plan.  Now is a “good time” to talk.

“Planning is bringing the future into the present so that you can do something about it now.” Alan Lakein

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