Why it is so Important to Have an Advance Directive. There are worse things than death.


26 year old who just had a stroke.
35 year old who has multiple brain masses.
52 year old who never woke up after surgery.
22 year old braindead from a massive car accident.
19 year old paralyzed from the waist down in a snowboarding accident
87 year old who went into sudden cardiac arrest and now has multiple broken ribs. She later died in the ICU.

These were all real patients of mine. Healthcare isn't a pretty job but it gave me a tough dose of reality. People say they couldn't handle the smells of working in healthcare but I assure you, you'll get used to the smells. Let me assure you, you'll get used to the smells. These moments are the worst part of my job. Although it's not all bad. Those moments remind me that I still have compassion for people and healthcare hasn't completely chewed me up and spit me out just yet. I think my heart drops a little bit when I see an elderly person is full code. Full code means we do everything in our power to save them. That includes a tubes to help them breathe and eat.

Why it is so Important to Have an Advance Directive. There are worse things than death.

I'd much rather hold their hand as they pass instead force a feeding tube in them, restraints that tie them to the sides of the bed so they don't pull at all the tubes, or hold them down as I try to get a blood pressure.

If we can decide how we want to live our lives, we can decide how we want to die.
After a certain point we are torturing the patient just to prolong their life. That's not really living. I've done CPR on too many people who, had they just understood, likely would have opted for a DNR and died in a more dignified and humane way. I am all for life-saving measures, but reality is less glamorous and less optimistic than TV makes it out to be.

Why it is so Important to Have an Advance Directive. There are worse things than death.

People with advanced illness, or even simply advanced age, should really consider what they expect from their future and weigh that against the idea of being tortured on a gurney with the small chance of survival, only to be miserable in a hospital bed with an even smaller chance of returning to a normal or even fair quality of life. At this point in my life, of course, I would opt for all life-saving measures for myself (though I would rather be dead than be chronically in a vegetative state), but at some point in life, the scales should tip. Ignoring the issue and just accepting the default potentially leads to increased sadness and anguish for yourself and your loved ones down the road.

Family members long gone show up and stir the pot, questioning the plan of care and undermining the staff caring for them.
I once had to call security on a woman who was harassing staff after a patient was put on hospice. The cancer had spread to his entire body. He cried if I took a blood pressure on him.
He had cancer for 7 years and she never visited him. I think she felt guilty.
I prefer to think of the chaos as inadvertent and that the disturbers are just using an ineffective strategy for coping, which for them also includes guilt over the estrangement. Extending life gives another chance to have the relationship long ignored. The delusion, for them, is that even with that, they would most likely revert back to avoiding the relationship!

Why it is so Important to Have an Advance Directive. There are worse things than death.

Can't stress enough how important it is to have this conversation NOW. Let your loved ones know what your want. Take away the burden of having take that decision which inevitably carries a huge amount of guilt. Haven't met the first patient that has not told me they want to die at home and NOT in an ICU. Start the conversation, let your wishes be known, and get an advance directive. Get your stuff in order. This WILL happen. It's just a matter of time.

Quick Guide for you
Brain dead - Lights out; nobody home. Or as I say, the wheel is spinning, the hamster is dead.
Persistent vegetative state - Lights on; nobody home.
Coma - Lights out; somebody home.

Why it is so Important to Have an Advance Directive. There are worse things than death.
Why it is so Important to Have an Advance Directive. There are worse things than death.
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Most Helpful Guys

  • Zander_Gunn
    In 2015 I suffered pneumonia that got so bad it led to a cardiac arrest. I was deceased for (I know sounds impossible but I will explain) 20-25 minutes according to hospital records. What saved me from brain death was that I recieved CPR the entire time. I woke in ICU several days later absolutely crazy. I did not know where I was, thought my mom was a robot, that nurses had taken me home at night and just the craziest ideas, because I had brain damage from lack of oxygen. Anyways flash forward to now I am healthy with no disabilities and a normal life. That is why it's important to always fight for life. It may be a longshot but miracles happen.
    Is this still revelant?
    • Usually people who die after CPR have additional problems. CPR generally works for people who are otherwise healthy.

    • Like the patients I stated in the beginning of the my take, the 26 year old and the 19 year old both made full recoveries. Meanwhile, the 52 year old had a very risk surgery and the 87 year old had many, many issues that she was a basically a ticking time bomb until she went into cardiac arrest.

  • XavierSteele
    As morbid as this sounds you are right, I just finished one. Mostly because just here on the 9th I had an accident which put me in ICU and the reason was because I had stopped breathing after the accident, not because the actual accident, but had it not been for being back at my friends garage I don't think I would be typing here today. Looking back though I realized that this is the second time in a few months and rather than have someone have to make that decision I would much rather know that I am not kept on some type of artificial support if there is nothing left of my mind.
    Is this still revelant?

Most Helpful Girls

  • DeeDeeDeVour
    I've had an Advanced Directive initiated originally as a college project that turned real & legal by my "Lawyer by day & Professor by night" who was so impressed by my practicum dissertation that he wanted to legalize it immediately. I just kept on amending it throughout the years with the help of various Lawyers.
    Is this still revelant?
  • Thalia95
    I agree but for me being Quadriplegic be worst not able to do things for myself be a prison.
    Is this still revelant?
    • Elliot_F

      Have you read Jojo Moyes's book, Me Before You?

    • @Elliot_F Personally, I read the book a while back. When I was on the fence about euthanasia, that book convinced me to change my mind. Now I'm for euthanasia when the situation permits it. I really felt bad for the character in that book. I'm such an independent person that all of a sudden becoming a quadriplegic would be devastating. @Thalia95 you should read it, if you haven't.

    • Elliot_F

      Yes, it's a fantastic book! I loved every sentence of it.

    • Show All

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What Girls & Guys Said

  • Doctor_Strix
    This post should be blasted all over the Internet. In fact, Health Insurance companies should make this one of the beginning steps towards coverage.

    I always insist to my patients to get this done. Especially before any procedure. Even vasectomies.
    • I asked my dad about him and my mom doing an advance directive the other day. He just told me I was obsessed with death šŸ™„ Luckily my mom saw reasoning and they're going to do advanced directives for each of them.

  • Waffles731
    I don't believe this is what happens to a persons soul/spirit in the case of coma but it doesn't change the fact I've had this nightmare more than once, about being completely unconscious in a vegetative state and my soul is completely trapped and it feels like agony every second of the dream.

    I don't have the money to get it notorized but I've openly told my family that in cases of shit like this to simply unplug me.

    I had that nightmare again last week and its awful every time
    • Waffles731

      Thinking about it, this dream might have something to do with an X-Files episodeI saw

    • I never got mine notorized. I just told my primary care what I want. Plus it says on my driver's license that I'm an organ donor.

  • Gedaria
    It's hard to generalise, it's up to the person.
    The one I have is if you have gone as far as you can that's the end , I don't want this being on machine.
    But some people cling on to life any life is better than no life. Sorry that's not for me...
  • talloak
    Excellent points. I need to ask my doctor how to do this. I hope you can hang on for such a difficult job. You seem to be making an enormous difference!
  • My Brother has a heart attack and was down for several minutes before medics found and revived him. Later MRI's showed no brain activity and I was in the absolute shitty position of having to "lobby" to pull life support against the wishes of his bereft wife.
    I finally was able to build a case, and find a doctor to help, and convince my brothers wife to pull the plug.

    Chalk this up to an enormously shitty day.
  • cataliness
    Totally agreed and I think everyone should be able to choose this if we're talking about healthcare.
    There is an amazing docu with Terry Pratchett that follows the 'assisted dying' process that any dying man can choose to go through in Switzerland, the only country where this is possible and legal. It's heavy and shocking. Of course it involves a lot of courage but when faced with such a sentence it can become the only dignifying option.
  • elduderinosupreme
    I'm dnr on my medical record. Fuck that. If I ever get cancer fuck controlled radiation poisoning. I'd rather have a sudden case of lead poisoning. For those who dont get the reference bullet to the dome. I will not suffer for others enjoyment. Good thing everyone doesn't give a fucj about me. Makes it easier.
  • DanOh2018
    Do what it takes to bring me back. I don't mind pain and trauma. I won't go quietly.

    I've been mangled in collisions and pinned back together. Sure I'm often in pain but I'm still here and I enjoy most of it.
  • raulroy91
    I have debated with the same question for a while.. but for as good as it sounds.. the UN has not accepted it as a human right yet... But may soon considering the aging population.. coming back to the topic.. the simple reason... People will find a way to take advantage of this if implemented
    • People already take advantage of the healthcare system. And everything in general.

    • raulroy91

      Very true..!

  • Woodsrdr
    There are many fates worse than death. One of my offspring is an RN and I never hesitated or second guessed giving her a durable medical power of attorney for myself. I have a DNR for making sure I don't end up a vegetable as well as any type of burden on my family and friends. Currently, tattoos are not considered a legal notice where I reside. If they ever are, my DNR will be tattooed on my chest for any EMT, Firefighter, Nurse, Doctor or any other person that cares enough to try to save my life when the chance of any quality to that life are nonexistent. I'm not afraid of dying at all. I'm afraid of being "Alive" only to drain the people I love and care about of their quality of life while I lie in a bed somewhere. I have great relationships with the people I want them with. If I can't do certain things myself and other things by or for myself, I don't want to waste the air I would breathe.
  • Nikola99
    No there is not a worst thing then death
    • Being forced to live forever and watching my family die around me would be worse. Did you not read the my take?

    • Nikola99

      No. and i don't agree. i would love to live forever. i don't care if i have yo watch loved ones die every single day

    • Well I guess we have different priorities then.

  • DonCachondo
    Thank you for posting this!!! I love it
  • SecretGardenBlood65
    Good take.