101 Things the Fire Department wishes you knew



Tuesday, August 4

The Will of the Living

I was recently a witness to how a person's last few hours should be handled. Not because it was what I wanted, but because it was what HE wanted. This is in line with a current rift in politics at the federal level which encourages persons in this situation to put pen to paper about their end of life wishes.

Before I am dispatched to the report of CPR in progress, a bit of background.

Our new friend is a recipient of medicare and was, a few months ago, enrolled in a hospice program and was allotted around the clock care from 2 care takers, each on 12 hour shifts. Each of the care takers kept a log book which they kept and one large book which stayed at the gentleman's home. This included a very accurate meds list, recent complaints, menu and amounts of food eaten as well as his activities for the day. This was the most in depth record keeping I have ever seen.

Last night the care taker passed along that her client had been more short of breath than usual and was too tired to do his usual walking laps around the small house. The day time caretaker called the agency and requested a nurse come out to evaluate him in case he needed an adjustment in meds or oxygen. When an appointment was made in a few days time, the care taker fought and convinced the agency to send someone immediately because he, "Was so tired and sad."

The nurse who answered the call was equipped with a high tech laptop which held all the information for the large amount of persons currently under her supervision. When she arrived at the house, the caretakers had made their client comfortable in his favorite chair, facing a photo of him as a younger man, taken long before the painful cancer began to eat him alive.

The nurse evaluated him and determined there was no adjustments that could be made and offered to stay and help the caretaker deal with what would likely be happening soon. She made the caretaker breakfast and finished some paperwork on the computer when they both saw him lift his slumped head, look at them and close his eyes.

He was gone.

The nurse removed the original copy of the DNR from the wall over the bed and taped it to the front door while calling the non-emergency number for a Paramedic to pronounce death. The nurse then contacted her agency, the gentleman's primary care doctor and the funeral home, all before I arrived at the scene with a dispatch of:
"Man down resuscitation, CPR in progress, gathering further."

I rang the bell and noted the DNR on the door. The nurse meets us, giving us the details in the stairway, and leads us to the gentleman still in the chair. We do our assessment finding him clinically dead, moving to the next step, contacting the Medical Examiner for a notification. Often this involves a police officer to standby with the deceased and a 1-2 hour wait for an ME to arrive and perform their field assessment before releasing the body to a funeral home or gathering for an autopsy.

On the phone I mention the patient's nurse is at the house and has already notified the primary care when he says, "Really? Cool, let me talk to her."

They have a conversation that ends with, "Thank you Sir," and hands the phone back to me.
"Expected, witnessed and notified, you don't need us, the nurse says the funeral home is already enroute."
"That's it?" I ask, usually I have to give them a 10 minute report on meds, history, family etc etc.
"Yup, thanks." and the line goes quiet.

The nurse asks if we can place the gentleman back in the bed to help the caretaker's cope. The one on duty is slowly giving into her grief in the kitchen as the night girl arrives and they embrace.

No tubes, no drugs, no violent CPR to prolong what was clearly a painful and excruciating life. He made sure, months ago, to make out a living will which explained his wishes should his heart stop beating, which led to the DNR.

Not to mention freeing up the other resources to those who may need them.

When you finish reading this look into a living will. There are a number of websites that will guide you through it, I found THIS one just doing a quick search. The wife and I were lucky enough to get help from a lawyer group that helps Firefighters for free and sat down a few years back and did the whole thing. Then we took the copies, put them in a binder and told the family that if anything happens, trust the paper, not the person. End of life decisions, funeral arrangements, custody, everything needs to be addressed.

Make sure those around you know what your wishes are and you can move along to the next step on your terms, not those of the EMTs responding.

Our friend did it and not only did it make an impact on his life, but on mine. And, hopefully, yours.

6 comments:

MotorCop said...

Well said. And, thanks. It is on the list of things to do...sooner rather than later.

Cheers.

911 and the Randomness.. said...

Very well written and very heartfelt. My Man has been putting this off for a long time. Cops are supposed to be smart... No offense meant to any other LEO, just wish my man would get it done, Lord knows I don't want to make that call.

Ckemtp said...

Nice post Happy. Well said.

Medic7 said...

Great post Happy. My wife and I did the same thing a few years ago. Prearranged our funerals, got living wills... the whole shebang. Both of our families have copies, our attorney has one, we each made a copy for our PCP (it's in our records) and there's one in the "important papers file" in the house. Overkill? Maybe. But the peace of mind is worth it.

medicblog999 said...

Great Post HM,

Im going to take a look at that site and sort something out over here. Mrs999 and I have been talking about it for ages but we just never seem to get round to it. Thanks for the reminder.

As for the post, coming from an oncology and hospice background (in my early nursing career), I really understand the importance of a 'good death', both for the patient and the family.

I dont find it hard at all to stand back and let nature take its course when everything is put in order and is above board. I do however, find it traumatic when the family are saying they have a DNR but cannot produce it!

Mystery Medic said...

I live by the "ya got ten minutes rule"...

Play with my corpse for 10 minutes then F off!!! I'm DEAD!!!

Most of us that have run a code have gotten the patient back after 30+ minutes and we know we only kept an ICU nurse employed for a few weeks. It's not for the patient. Sometimes I think we should start the clock when we walk in and work a code. No 3 rounds and were done. Hands on, tick, tick, tick, ding 15 minutes, Pop-Tart done...

We give hope, we get people back that live on machines until someone finally says pull the plug, time to move on with life. Nothing wrong with that though. Some people need closure with a heartbeat. We have to remember that when we work a code that it's not always about the patient but of the friends and family that need it. Such is life.