Getting Your Family’s Affairs In Order

 

# 6017

 

 

Last January I wrote of my elderly father’s brush with pneumonia last Christmas, and the steps we had taken in advance to make sure his wishes were respected regarding his treatment.

 

I’m happy to say, he survived that bout, and is still with us, having recently celebrated his 87th birthday.

 

This week, another family member living in another state – also in her mid-80s – underwent major lung surgery, and her recovery is apparently not going well.

 

While her children believe she would not want heroic measures taken at this point (i.e. life support), she is  - at least for now - unable to make her wishes known, and they are without legal guidance.

 

Her children are now scrambling to see if they can find a living will, or if she had assigned a health proxy (things she should have done pre-surgery), all the while being faced with making increasingly difficult medical decisions.

 

I don’t know how this medical drama is going to turn out, but I do know that this angst ridden family vignette is replayed in hundreds of hospital waiting rooms every day in this country.

 

Frankly, this is a conversation – and a legal matter – that everyone needs to deal with before they end up in a hospital, or on an operating table.

 

While perhaps not the happiest of yuletide conversations - this is the time of year when many families get together - and that makes it a perfect time to get your family’s affairs in order. 

 

That means updated family and medical histories on everyone (see A Family Affair), and putting together the legal documents to ensure your wishes are respected should you be unable to direct the course of your own care.

 

With that in mind, below you’ll find a reprint of a blog from last January, on living wills, health care proxies, and DNR orders.

 

 

On Having `The Conversation’

(First printed 01/03/11)

 

I don’t generally put personal anecdotes in my blog because . . . well,   I’m really not all that interesting.   But today, an exception.

 

My father, who turned 86 last November and now lives with my sister in another town, contracted a serious respiratory infection over the Christmas holidays. By late last week he was in pretty rough shape with wheezing, shortness of breath, weakness, and violent coughing.

 

My sister took him to his doctor, who fearing Dad had pneumonia, wanted to hospitalize him.

 

Dad refused.  Adamantly.

 

All Dad really wanted was to go back to his own bed. If something `bad’ happened, he said, so be it.  Better at home than in some strange hospital.

 

His doctor, after several futile attempts to talk him into going to the hospital, gave up.  She wrote him an Rx for Zithromax, and let him go home with the promise that if he got worse over the weekend, he’d go to the emergency room.

 

Dad muttered a diplomatic, but completely non-binding,  “We’ll see.”

 

I am pleased to tell you that the worst did not happen, and Dad is doing much better after 5 days at home on an antibiotic.

 

But, as Dad is quick to remind people, when you are 86 years of age – and have the kinds of health problems he has - you really shouldn’t be buying any green bananas.

 

Dad has serious (and inoperable) coronary and carotid artery issues, has had several serious bouts with cancer, lives with chronic back & hip pain, and his quality of life is continually declining.

 

Dad believes he is approaching the end of a long road, and feels no need to take extraordinary steps to prolong that journey beyond whatever nature intends.  He’s made that abundantly clear to his kids, his doctors, and to anyone else who will listen.

 

Which is why Dad, my sister and I have had `the conversation’.

 

We’ve discussed, in detail, exactly what Dad would want us to do if he were unable to make medical decisions for himself.

 

In fact, a few months ago Dad asked if I would get for him a legally binding Do Not Resuscitate (DNR) order, so that if something happened to him, and an ambulance were called, no heroics would be performed.

 

Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

 

Dad now proudly has the bright yellow DNR order posted over his bed, and carries another credit-card sized one in his wallet.

 

In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location. 

My twin brother and I, both former paramedics (hey, it was a hereditary defect), and my sister fully support Dad’s decision to have a DNR.

 

We’ve also had (for many years) a living will and a Health Care Proxy drawn up for Dad, so either my sister or I can make decisions regarding Dad’s health care should he no longer be able to.

 

As an aside, I’ve had a living will and an assigned Health Care Proxy in place for decades, to ensure that my wishes would be respected if I were suddenly unable direct my medical care.

 

Frankly, I consider them absolutely essential for all adults to have.

 

These are difficult subjects for many people to discuss, and so far too often, they get put aside until it is too late.  But better to talk about it now, and to have the proper papers in place, than to face a family medical crisis unprepared.

 

As a former medic, I’ve seen the anguish that relatives have suffered trying to make a life or death decision without input from the patient.

 

And I’ve also seen what happens when family members argue over what should be done about a loved one on life support. These are deeply emotional issues, and can create life-long rifts in the fabric of families.

 

While nothing can eliminate the emotional trauma that comes with a medical crisis, making rational decisions now – and making them known and binding – can greatly reduce the strain later.

 

Take my advice.  Whether you want heroic measures taken, or not.

 

Make your wishes known.

 

Have the conversation.

A Family Affair

 

 

 

Note: the following essay is a slightly edited repost of a blog I posted a year ago called Thanksgiving Is Family History Day.

During a medical emergency, having an accurate and current medical history available can be lifesaving. And making your wishes known about the types of medical treatment you would desire if you should become unable to direct your own care can save you, and your loved ones much anguish later.

 

 

# 5972

 

 

As a former paramedic, I am keenly aware of how important it is for everyone to know their personal and family medical history.

 

And as a son whose father turns 87 tomorrow, I’ve been charged with creating and maintaining my Dad’s medical history for a number of years.

 

And of course,  I also maintain one on myself.

 

Every Thanksgiving since 2004 the Surgeon General has declared Thanksgiving as National Family History Day. Over the holiday weekend - while you are visiting with family - is an ideal time to ask about and share family medical histories.

 

The CDC and the HHS have a couple of web pages devoted to collecting your family history, including a web-based tool to help you collect, display, and print out your family’s health history.

 

Family History: Collect Information for Your Child's Health

Surgeon General's Family Health History Initiative

 

Using this online tool, in a matter of only a few minutes, you can create a basic family medical history.

 

I’ve highlighted several other methods of creating histories in the past, which you  may prefer.  A few excerpts (and links) from these essays.

 

First, I’ll show you how I create and maintain histories for my Dad and I.   This was featured in an essay called A History Lesson.

 

Today, though, I’m going to impart a little secret that will ingratiate yourself with your doctor and not only improve the care you receive, but also reduce the amount of time you spend in the exam room.

 

When you go to your doctor, have a brief written history printed out for him or her.

I’ve created a sample based on the one I use for my Dad (the details have been changed).   It gets updated, and goes with him, for every doctor’s visit.

 

And his doctors love it.

While every history will be different, there are a few `rules’.

 

• First, keep it to 1 page.     Even if the patient has an `extensive history’.   If your doctor can’t scan this history, and glean the highlights, in 60 seconds or less . . . it isn’t of much use.
• Second, paint with broad strokes.   Don’t get bogged down in details.  Lab tests and such should already be in your chart.
• Third, always fill in a reason for your visit.   Keep it short, your doctor will probably have 10 to 15 minutes to spend with you.   Have your questions and concerns down in writing before you get there.
• Fourth, list all Meds  (Rx and otherwise) and indicate which ones you need a refill on.   If you have a question about a med, put a `?’ next to it.   And if you have any drug allergies, Highlight them.
• Fifth,  Make two copies!   One for your doctor to keep, and one for you.  As you talk to your doctor, make notes on the bottom (bring a pen) of your copy.  

Once you create the basic template (using any word processor), it becomes a 5 minute job to update and print two copies out for a doctor’s visit.

 

I get raves from every doctor I present this to.  They have all said they wished more people would take the time to prepare for their visits.

 

The history above is great for scheduled doctor’s visits, but you also should have a readily available (preferably carried in your wallet or purse), EMERGENCY medical history.

 

I addressed that issue in a blog called Those Who Forget Their History . . . .   A few excerpts (but follow the link to read the whole thing):

 

Since you can’t always know, in advance, when you might need medical care it is important to carry with you some kind of medical history at all times.  It can tell doctors important information about your history, medications, and allergies when you can’t.

 

Many hospitals and pharmacies provide – either free, or for a very nominal sum – folding wallet medical history forms with a plastic sleeve to protect them.

 

I’ve scanned the one offered by one of our local hospitals below. It is rudimentary, but covers the basics.

 

 

In a medical emergency, minutes can make the difference between life and death.  And even in less urgent cases, having all of this information can go a long ways towards speeding your treatment.

 

You should make it a point, this week, to get medical history forms for every member of your family – regardless of their age – and fill them out.

 

And a couple of other items, while not exactly a medical history, may merit discussion this weekend in your family as it has recently in mine.

 

First, adults should consider having a Living Will, that specifies what types of medical treatment you desire should you become incapacitated.

 

You may also wish to consider assigning someone as your Health Care Proxy, who can make decisions regarding your treatment should you be unable to do so for yourself.

 

Elderly family members with chronic health problems, or those with terminal illnesses, may even desire a home DNR (Do Not Resuscitate) Order.

 

Verbal instructions by family members – even if the patient is in the last stages of an incurable illness – are likely to be ignored by emergency personnel.

 

In Florida, the form must be printed on yellow paper. Different states have different requirements.  You should check with your doctor, or the local department of health to determine what the law is in your location.

 

 

My father, who has extensive health problems, requested a DNR earlier this year and now carries a yellow card in his wallet and keeps a yellow DNR form on the wall next to his bed.

 

Admittedly, not the cheeriest topic of conversation in the world, but for a lot of people, this is an important issue to address.

 

A few minutes spent this holiday weekend putting together medical histories could spare you and your family a great deal of anguish down the road.