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Daddy and I were sitting in rocking chairs on his front porch gazing across the marshes of the Colleton River when he quietly said, “Just let me go. I do not want all the chest compressions, the artificial airways, the resuscitative drugs, the defibrillators, or the IVs. I do not want the medications and the machines. I just want to die a natural death.”
Without realizing it Daddy had given a most precious gift. He had graciously spared his family the stress of making a decision about his health care preferences. He had clearly stated the desires of his heart. In death, as in life, he wanted nature to run its natural course. He had made his decision and he was asking me to honor him by honoring his decision. By clearly communicating that he wanted to die a natural death, he made his preference about his medical care known before we were faced with serious injury or illness.
A Conversation That Must Be Held
A Do Not Resuscitate (DNR) order is kind of advance directive. It is a medical order to provide no resuscitation to individuals for whom resuscitation is not warranted. It means no cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Some people are surprised to learn that unless given other instructions, healthcare professionals must try to help any patient whose heart has stopped or who has stopped breathing.
My rocking chair was still. You see, I am a healthcare professional. I meet with people every day who have “Do-Not-Resuscitate” orders and I regularly find myself in situations where I am asked to discuss with patients whether they want to or should have resuscitation following a cardiac arrest or life-threatening arrhythmia. Like many other medical decisions, deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest involves a careful consideration of the potential likelihood for clinical benefit with the patient’s preferences for the intervention and its likely outcome.
Decisions to forego cardiac resuscitation are often difficult because of real or perceived differences in these two considerations. Daddy had erased those differences. I knew the poor prognosis for clinical intervention and he had shared his preference not to seek resuscitation. The conversation on advance directives is one that must be held. So, on this warm summer afternoon I asked my loved one if he had executed advance directives, if he had a living will.
People who are seriously or terminally ill are more likely to have an advance directive. For example, someone with terminal cancer might write that she does not want to be put on a respirator if she stops breathing. This action may reduce suffering, increase peace of mind, and increase her sense of control. However, even if you are in relatively good health, as Daddy is, you should consider an advance directive. An accident or serious illness can happen suddenly, and, if you’ve already signed an advance directive, your wishes are more likely to be followed.
I notice the tide has turned. The waters are ebbing; they are leaving our creeks and rivers and flowing to the ocean. It has been this way since time began. It is the way of life. It is natural.
