While others write hilarious blogs about potty training and the challenges of young families, real as they are, this blog is about the other end of life, the POLST…big pink cardstock?…affix it to the refigerator?…(Physician Oders for Life-Sustaining Treatment)? I had to use it (sort of) last week. Now I have more questions than answers and need advice from my daughter the nurse.
Years back Mom checked ALL the boxes. Now at 94 and with Alzheimer’s Disease she still insists she wants only comfort measures: do not resuscitate, no nutrition by tube, no antibiotics if unconscious, with the phrase, “Patient prefers no transfer to hospital for life-sustaining treatment,” outlined for emphasis. She just wants to pass into the arms of Jesus and only be kept as comfortable as possible at home. Before this intestinal virus, she was bowling in three leagues every week. Granted, her average is slipping, but she still beats any of my grown children.
Still, when quite frightened and confused last week as I checked on her before going to bed myself, she wanted the doctor at 9:30 p.m. An ambulance was the only way I could “keep her comfortable,” so off we went. The paramedic’s reaction to the POLST surprised me a bit. He did not hook up an IV en route. It turns out that her blood sodium, from an intestinal virus and dehydration, had plummeted to near convulsion and coma levels. As her appointed decision-maker in matters of health, I agreed with the ER doctor’s suggestion to correct that imbalance with IVs of sodium. It took two days before they released her from the hospital, albeit in a much more confused and very weak state.
Was I right? I did not carry out her desires as directed on her POLST. Instead I did what she asked for when in distress and not very rational. She entrusted me with the job of being rational when/if she was not. But was I rational? One hundred years ago, Mother would have gone home to be with Jesus from this minor illness. Today, doctors use one little needle and brought her back to functioning, albeit having taken quite a hit physically and mentally.
One little needle, one pink paper, but did I perform one little act of kindness or did I, in fact, disregard her wishes? Maybe in today’s world of medical advances, I’m bound to disregard her wishes. Whew, I definitely need some advice. Guidelines must exist for these kind of decisions!