The Doctors Listened
This past Christmas, my 82 and 83 year old mom and dad drove 1100 miles from Iowa to stay with our family in Spartanburg for seven weeks. We had a great holiday and were settled in to our visit when we realized that Mom wasn’t doing well. Mom has multiple chronic illnesses including heart and vascular disease, chronic renal failure and mild dementia. We realized that she was weaker, more confused, was spending more time in bed, and eating and drinking less. She eventually suffered a fall in the bathroom.
Mom had no physician in Upstate SC, so we had to take her to the emergency room. The first physician to evaluate Mom asked diligent questions about the events that led us there and her medical history. The usual lab work was drawn. A short time after he left the room, a gurney arrived to transport Mom for a CAT scan. Surprised, I questioned the reason for the scan, and requested that Mom not be taken for this test. The physician soon returned to ask why we did not want Mom to have this scan to rule out a head injury from the fall. I explained that she did not hit her head when she fell and that she had not shown any change in her cognitive or functional status since the fall. I also explained that mom had experienced the symptoms she was presenting many times in the past, was treated palliatively in her home setting and we hoped for a similar intervention here. He listened to me and my dad, respected our decision, and cancelled the CAT scan. Because the labs verified that mom had a urinary tract infection and was in acute renal failure, IV fluids and antibiotics were started.
Soon after, around the corner came another gurney to take mom for a chest X-ray. Again I cancelled the trip and again we had a visit from the physician. He explained that the X-ray was to “rule out” any blood clots in the lungs, since mom was having some shortness of breath. We discussed the fact that mom had a Living Will and that she did not want aggressive measures or treatments for life-threatening events. Mom was often short of breath due to heart disease and it usually subsided with rest and decreased anxiety. The doctor agreed that her lungs were clear and that he would honor our wishes.
The decision was made to admit Mom to the hospital for management of her acute renal failure. Around the corner came another gurney, this time for an ultrasound of the kidney. Again, I asked, “Why?”, and again, we had a visit from the doctor. He explained that standard protocol for admitting someone in renal failure is an ultrasound of the kidney. I told him that Mom only has one kidney which functions at about 40-50%. Her Living Will clearly states that she does not want aggressive measures if this kidney fails. She has always been very clear that she does not want dialysis, even temporarily. She believes that when God is ready to call her home that renal failure will likely be what causes her death. For years, she has reviewed the wishes outlined in her Living Will and asked that we honor and defend her wishes. Mom’s doctors were supportive and encouraging, watching mom’s labs and her cognitive and functional status improve, while honoring our request for non-aggressive care.
Because we had wonderful physicians that listened to us and helped us honor Mom’s (and Dad’s) wishes, Mom avoided stressful and unnecessary tests that saved thousands of dollars and would not have changed the outcome of Mom’s two-day hospitalization. A week after her release, Mom and Dad were able to return home to Iowa.
Our physicians were willing to support us in our desire to ensure Mom was comfortable, her symptoms were managed, and she was treated with effective but simple measures. I want to thank them for LISTENING! It would have been much easier to follow the standard protocols and not take the time to address our many questions and concerns.
In my role as a nurse at Interim Healthcare, one of my responsibilities is teaching Advance Care Planning in churches and community groups. I am comfortable advocating for my mom and dad most of the time, but even I admit, that with all my experience in hospice and healthcare, teaching people to have a PLAN in advance, it was still not easy to confront the expectation that we test, test, test and treat, treat, treat. It is reassuring to know that when you have a plan that is written, and when you have discussed that plan with your family, your healthcare power of attorney and your doctor, it is easier for those that love you to honor, respect and defend your wishes.