Pembirdie

Tag: advance directives

  • Something everyone needs

    Everyone should have advance directives. Advance directives specify what kind of medical care you would want in the event you are unable to express a decision. Ideally, these should be written down, along with your designation for medical power of attorney (POA) – the person who would make decisions on your behalf if you can’t make them yourself. If you don’t want your closest relative (spouse, child or parent) to make decisions for you, then a document naming medical POA is essential.

    Perhaps just as important is talking with the person who would be your medical POA so they know what you would want. Ideally, if your medical POA is making decisions on your behalf, it should feel relatively easy for them because they already know what you want – they are just relaying the message to the medical team.

    Advance directives usually have a question about code status, about what you would want if you were expected to be permanently unconscious, or have an incurable and rapidly progressive medical condition that will result in death. Usually they ask if you would want tube feeding for nutrition if you can’t eat. They might ask how you would like your pain controlled, and if you want your organs donated if possible.

    One thing to note is that as humans, we aren’t the best at predicting what we will or won’t be ok with in the future. There is a principle called hedonic adaption that says that we tend to get used to nice things pretty quickly. For instance, in medical school I had the Lasik procedure. In the days that followed (after the sand-in-the-eye feeling went away), it was amazing! No need to put on glasses or deal with contacts! Everything clear! But pretty quickly it became normal.

    Now, maybe every few months I remember that my eyes didn’t used to see 20/20 and I feel a wave of gratitude, and yes, the irritation of dealing with foggy lenses or a misplaced contact doesn’t happen any more, but I can’t say that I’m particularly happier than I was before I got Lasik. My body got upgraded, and my expectations upgraded as well.

    Fortunately, the same thing can happen when our bodies downgrade. Studies show that people are able to adapt to their misfortunes. Again, I’ve experienced some of this myself. With my current hip problems, I can’t go on a casual walk or participate in a lot of fun activities. This has definitely been frustrating and life-altering and I know I’m missing out on things, but am I sad about this all the time? Nope. I don’t think my happiness level is hugely different. If I was miraculously healed and back to my “normal” self, I could see myself being a lot happier – for a week or two, maybe a month. At that point I suspect I would have adapted to my new reality. 

    SDG

  • Side effects of CPR

    Generously, one in three people who undergo cardiopulmonary resuscitation (CPR) in the hospital will survive. (Success rates are lower outside the hospital.) Congrats, that’s what you were hoping for! CPR does have side effects, however… but you only experience the side effects if it successful aka you are still alive.

    1. Broken ribs. This is the most classic side effect. The older you are, the more likely this is going to happen, because ribs get more brittle with age. If you are a little old lady, your ribs are going to snap like toothpicks. What do broken ribs feel like? As far as I can tell, nothing good. Breathing will be painful, so the temptation is to take little tiny breaths instead of big ones and to avoid coughing at all costs. Unfortunately, doing this sets you up for pneumonia, which you are already at increased risk for being in the hospital. So we’re going to be asking you to take those big, deep, painful breaths anyway. You may need to go on opioid pain medication in order to do so, which comes with its own litany of side effects (like constipation, confusion, and dependence).
    2. Brain damage. About one third of people who survive CPR will have brain damage. This does not mean you are an unconscious “vegetable.” But maybe you are. Or maybe you just can’t live by yourself anymore because it’s too unsafe.
    3. Trachea/vocal cord damage. If CPR goes on for more than a few minutes, we are going to try to place a breathing tube. In the process, the tube may injure your throat, including the vocal cords. Swallowing may be painful for about a week. Your voice may never be the same.
    4. More time in the hospital. No one comes out of CPR healthier than when they went in. You will likely end up in the intensive care unit for close monitoring, which is going to involve more tests, blood work, and interruptions. Almost certainly your hospital stay will be prolonged. Longer stays in the hospital mean greater chances for other things to go wrong.
    5. More likely to not go home. You’ll be weaker and may need to spend time rehabilitating in a nursing home. If you are fortunate, you will rehab back to home or move into an assisted living where you have more support. If you’re less fortunate, you’ll be a permanent nursing home resident.
    6. More likely to return to the hospital. Generally, hearts don’t just stop beating out of nowhere. You probably have some serious medical conditions that are not going to go away. You may also have more health problems as side effects of CPR. (See above.) As a result, don’t be surprised if you continue to get ill enough to require repeated hospitalization. Your doctors certainly won’t be.
    7. More likely to die. A study examining CPR in older adults with medical problems like heart failure, COPD, cirrhosis and cancer found more than half of them were dead in 6 months. 

    Again, you only get these side effects if CPR is successful: the alternative is being dead. The older, sicker and more frail you become, the more likely you will experience these side effects and the more severe the side effects are likely to be. You will also be less likely to survive to experience them.

    In general, if you are under sixty, I’d say it’s worth doing. (That recommendation would change if you have metastatic cancer or other severe health problems.) Over sixty becomes more gray as people accumulate more health problems. Ultimately, the decision is up to you, but it’s important to know what your decision means.

    SDG