ER Doc: The Day I Meet You in the Emergency Department Will Probably Be One of the Worst of Your Life

You know I usually use this space to share information and cool finds related to deathcare (burial/cremation/natural burial/etc) with you, and that compelling you to write down and share your final wishes is a particular passion of mine.

But it’s really only one piece of the puzzle, a book in the series.  Being responsible about and ready for your end of life issues starts with advanced directives and medical power of attorney, and runs all the way though having created and shared good legal documents for your estate.   And these steps include conversations and discussions the entire way, making sure your loved ones, the ones who will mostly likely be making these decisions for you and enacting your wishes, are well aware of them.

I would be remiss if I didn’t occasionally preach from that sermon book as well!

So in that vein, I wanted to share this compelling essay from an Australian ER doctor:

The day I meet you in the emergency department will probably be one of the worst of your life

The final-moments conversations she details in her article could well apply to you, or the vast majority of folks around you, who haven’t found time or space to talk about the end-of-life healthcare decisions with their loved ones.  Who are too scared of death to realistically discuss their desires around CPR/breathing tubes/dialysis/heroic measures, which in the moment compels the fear of loss to throw a Hail Mary when better,calmer judgments faced with the same health crisis might make a different choice.

The truth of her profession, Dr. Witt (Ash, as she introduces herself) says:

You see, as doctors, we have the ability to keep a person alive indefinitely. If our lungs fail, we can put a tube down your throat and have a machine breathe for you. If your kidneys fail, we can attach you to a machine that filters the toxins from your blood. We can even mimic the function of the heart. We can fill your veins with tubes and lines and attach you to life support…

If a person’s heart stops, we can perform CPR. CPR requires me to put my weight onto your mum’s sternum and push. To do this effectively, I will inevitably break some of her ribs. This sounds horrible, but if we don’t do that, the heart doesn’t pump blood to the body and without blood, we die.

A young heart might be likely to restart, whereas statistically, mum’s 89-year-old heart won’t and we would perform traumatic CPR until we made the call to stop.

But despite that, she sees it all too often in her emergency department:

When I am the medical registrar at a code blue that involves doing CPR on an elderly person, I usually go home after work and cry. We’re causing so much trauma to a frail person’s chest, when realistically every doctor in the room knows the outcome will be death – regardless of whether we do CPR for 10 minutes, 1 hour or 3 hours. The patient’s ribs are cracked and their final moments are traumatic. They are surrounded by doctors, not their children. That’s not a “good” or dignified death.

Does that sound at all like the final moments you want for your mother?  Your father?   Anyone you care deeply about, or even like a little bit?

Why do we do it then? Because if you insist you want “everything” done, that’s what doing everything means. If you don’t write an advanced care plan telling us what matters to you, we do the default option….Some people want everything done and want tubes and life support and an admission to ICU. In my experience, when people understand what “everything” means, they don’t want that at all.

Much like decisionmaking around funeral choices,  research, discussion, and advanced planning can make a world of difference in the quality and direction of the choices we make for our loved ones at the end of life.    If you’ve never talked to your mom, your uncle, your husband about their beliefs around heroic measures and aggressive but long-shot treatments, about their wishes for the kind of death they want–you may not feel comfortable speaking the words that lead to stopping their only hope (even so small) at living through the moment.   And that may ultimately get you to the same place, only with your dad’s last hours being full of tubes and treatments and trauma.

The last word is Dr. Ash’s:

The day I meet you in ED will probably be one of the worst days of your life, if you’ve had this discussion, the knowledge that you’re respecting mum’s wishes will make your pain easier to bear, I promise. Please have this talk this week, regardless of whether your parents are 60 or 100. Your future self will thank you for it.

Amen.

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