Mrs ERJ and I are thrashing through our "Advanced Directives". I will be Mrs ERJ's decision-maker and she will be mine. We have a second person, an alternate, lined up in case the primary is not available. That can happen, for instance, if we were both in the same auto accident.
One of the difficulties is providing the alternate with some simple, clear-cut questions to ask the surgeon or attending doctor and communicate what the GO-NOGO criteria will be.
So, the picture in my head is that if I can sit in a wheelchair and hold a fishing rod or a shotgun 60 days after the surgery or intervention then I want the intervention. If there is a 50% chance that I will have that level of capability, I want the intervention. If there is a 25% chance that I will be able to reach that capability in 60 days, I want the intervention. If there is only a 20% chance that I will reach that level of capability in 60 days...I think I don't want the intervention.
Critical to this process is that the medical caregiver who is providing the information not be aware of what the cut-off values are.
I need to have some tasks on "the other side" that give me a feeling of being productive, whether it be catching bullheads, carp or bluegills, or whether it be slaying bunnies, woodchucks and red squirrels intent on ravaging the garden and orchards.
Studies on how the human brain calibrations for various probabilities are pretty consistent. Most people are fairly well calibrated for 50:50 probabilities. The calibration gets shaky at 25:75 events and goes totally into the weeds at 20% probability.
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| May 31, 2022. Mrs ERJ was out-of-town and the tomato plants weren't going to plant themselves. That is precisely 31 days after I got whacked as I was crossing a street by a Malibu going 35 mph. |
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| I got a big assist from Belladonna. She moved the trays of pepper plants to the garden for me. And she didn't rat-me-out to Mrs ERJ. |
A physically-fit person in a wheel chair can probably run a zero-turn mower if there are not too many obstacles. If he is sufficiently motivated, he can probably do some straw-bale gardening and grow tomato seedlings, brew small batches of beer and, with a little bit of help, run a still. He might even be able to do a little bit of blogging on the side.
He can shake a bucket with corn in the bottom of it but he cannot chase cows and probably cannot close the gate.
Any thoughts?
Don't let the alternate know where he/she is situated in your will--ken
ReplyDeleteToo late for that. They already know that each heir get 20% of our outstanding debt.
DeleteAlready done. And my paramedic daughter has my medical POA. And we've discussed 'options. Good idea, and you won't know until you are IN that situation what you will do.
ReplyDeleteHaving to had dealt with this for both of my parents, planning all this ahead of time prevents a lot of headaches and heartaches.
ReplyDeleteAs we age and deal with various infirmities for most of us I think it’s important to be useful with those around us. Between back surgery and arthritis I’m chained to a cane and walker at age 76. I’ve had one of those “rotator” walkers for outside for a couple years. I’ve got two 12 by 24 hoop houses and a 12 by 24 green house that I can manage pretty well. I have had to let others do the fire wood except for making kindling and hauling wood with the tractor to the shed for them to stack. I say don’t give up, do what you can do and let others share the things you can’t do.
ReplyDeleteDad didn't want any extraordinary life saving measures taken. At 81 he had a stroke (life threating). The bleed in his brain was causing much pressure and pain. There were 2 choices, drill to relieve pressure or opioids for the pain. Since drilling was extraordinary and may save his life, he was given opioids for 2 weeks. The first 3 days they didn't work and the last 11 days they were increased. My mom and siblings were okay with that. I stayed away. It seemed wrong to watch him die when he could be saved.
ReplyDeleteThere was a time this wasn't an issue. You did what you could to preserve life.
If you don't want to be kept living, are you depriving someone of an opportunity to serve God by caring for you? Is choosing to die the same as suicide? Doesn't God control the quality of your life? Are you saying you know better than God when you should die? So many questions come up.
sam
Those are deep and personal questions.
DeleteFor my part, I separate "suffering" and "being a burden".
Jesus promised us that we will suffer. Jesus suffered on the cross and when we gracefully accept unavoidable pain we are confirming our brotherhood with Christ. Christian = follower of Christ.
Different people have different levels of tolerance for discomfort. Some people are incapacitated by a paper-cut. Others can have their left arm blown off and they keep operating the machine-gun.
"Being a burden" comes in a lot of flavors. Burdens can be short-term (like 60 days) or for the rest of our lives. They can be relatively trivial (like keeping an eye on Dad's credit card spending) or monumental (put life on hold and move in with Mom, change her diapers, feed her by holding her spoon.)
There is also the dynamic that our potential care-givers are also getting older and acquiring more responsibilities. Their finances and resilience might improve or erode. Most lawyers advise regular reviews of Advance Directives so that they comprehend those changing realities.
There are no universal, one-size-fits-all answers. Only questions...and you raised some good ones.
My parents had clear cut lines in their health directives, and still my mother's wishes weren't entirely honored. Something about the one facility not having a signed copy, I dunno, it's water under the bridge at this point. Interestingly enough, her line-in-the-sand was wiping her own ass. If she couldn't do that, pull the plug.
ReplyDeleteRegardless, have a copy and the talk with your children. We/I faced a problem w/ the morphine at EOL. It knocks you out until your body starves/dehydrates. Once you start, they keep you stoned until you're dead. I was not 100% certain Dad wanted the morphine. Check all the boxes on the forms, your kids will thank you.
Yesterday at the grocery store parking lot. I witnessed an elderly man pushing his wife in a wheelchair to a rather tall SUV. I watched him carefully lock her brakes and get out a homemade step for her.
ReplyDeleteI came over and offered to help, and he politely said no thank you.
I watched him from a polite distance as he carefully helped her by lifting her right leg and lifting her into that truck before putting everything away.
I saw love in action.
"A physically-fit person in a wheel chair can probably run a zero-turn mower"
ReplyDeleteI know five people in wheelchairs who all drive their own vehicles.
Some with simple mechanical adaptations, some with joysticks and voice controls; one uses a mouth stick to push buttons.
Adapting a lawn mower should be doable.
Yes, a properly written Advanced Directive is important. Fa too many people don't have one and when the unexpected happens it leaves everyone in a lurch. One issue however is it is not possible to be certain of the outcome from a medical intervention. While medicine is based on science there are tons of unknowns and variables. But not in your choices in writing ahead of time can make a hard time less hard, at least for family.
ReplyDeleteThe challenge my family had with my mother preceding her decision to go into hospice care was the absolute refusal of doctors & surgeons to provide meaningful probabilities against their recommended treatment options. Plus the side warnings from nursing staff about one doctor whom they tagged as "the eternal optimist, no matter the case."
ReplyDelete