Doctor, Do Everything

Life is a miracle to be treasured and we fight to keep that remarkable gift.  The courage and desire of patients is most evident when they say to us, “Doctor, I want you to do everything.”

By its very nature, this charge has no limit.  With this command, families and physicians rush into a world of consults, tests, surgeries, invasive procedures and treatments.  Patient beware. This instruction can lead into the dense fog of suffering.

Life worth saving is different for each of us.  For some life is only of value if we are independent and fully mobile.  For others just the chance to be with family or read a book is precious.  There are some for whom the beating of our hearts, even if our minds are not aware, is valued existence.  “Everything” is not universal.

The time comes to most of us when decisions need to be made about how much medical care we should receive.  It is critical that our family and doctors understand our individual limits. 

Let me be clear.  When you tell your doctor to “do absolutely everything,” you are releasing a hurricane. Perhaps you have no idea of what can happen? Left without control, health “care” can be a horror. Doctors can cause pain, isolation, invasion, fear, depression, disfigurement and unveil an existence that is less than useless life.  This is a place without pride, quality, or freedom.  Families and physicians left without limit often slip into a realm of futile care and nightmare.

There is of course a vital place for aggressive medical intervention. Proper therapy can produce marvelous cures. However, treatments must be balanced against reasonable possibility and personal desire.  Care should be guided by specific and attainable goals. These can be set only by each individual.

Now is the time to decide what “everything” means to you. If you are not certain about your choices, talk with your doctor, family and perhaps clergy. What is quality life for which you will fight? When would you want CPR performed?  Would you want a feeding tube? At what point would a respirator or dialysis be too much? Decide what price you will not pay. What is life you would preserve?

Communicate your desires to your family and physician.  I wonder if this should be a formal ritual.  Every family might have a “Planning Day.”  Once every couple of years we sit down, share a bowl of hot soup, our favorite drink and talk about dying.  Possibly, we should do this at lunch and follow with a quiet walk together.  Prayer optional, but not a bad idea.

Your instructions and beliefs should be written down.  A Living Will and Advance Directive for Health Care, outlining your wishes, can be drawn up with an attorney or downloaded off the Internet.  A POLST form (Physician Orders for Life-Sustaining Treatment) gives detailed instructions and is used by persons who are ill and nearing the end of their lives.   POLST orders must be reviewed directly with your doctor.

The best time for this kind of introspection is when you are feeling well.  Proactive decision-making will spare you and your family, confusion and suffering.  Understand the life you treasure.  Decide now and protect your future.

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