NEWSLETTER DECEMBER 2017
A Living Will is sometimes referred to as a physician’s directive but I think of it as a death with dignity document. You can request in writing that if you are in a permanent vegetative state, have a terminal illness or incurable condition, that your dying not be artificially prolonged. That you would request comfort care.
But who makes the call? Under the Kansas Natural Death Act your attending physician along with a consulting physician would have to make the determination that there can be no recovery from your terminal condition or vegetative state and that either your death is imminent or you can no longer experience a meaningful life.
One of the things about this document is that you have made the call and have taken the decision away from others so you can avoid the situation where you are in a hospital room and the family is out in the lobby arguing what to do. And keep in mind when you go into the hospital for surgery or what-have-you, one of the first questions that is going to be asked is “what code do we put on the chart?”
Finally, if you are of child bearing years and plan on having more children, you need to have language in your living will addressing a situation where you are pregnant. Will the interests of your baby take priority over your own interests? The doctors will need to know.
So what are some of the life-sustaining medical procedures available? Here is a summary for you.
A respirator is also known as a ventilator or a breathing machine. It can either totally or partially take over breathing if you are unable to breathe well enough on your own. A tube is placed down the throat and into the windpipe. The tube is usually as big around as your little finger. To ease discomfort, medication is sometimes used to relax the muscles or for general sedation. This may make you feel more comfortable and help the respirator work better.
It isn’t possible to talk or eat while on a respirator, so artificial feeding is often needed. Tape attaches the breathing tube to the upper lip and around the head. Another small tube is used to suction out fluid that may accumulate in the lungs.
A person who cannot eat is usually fed using a nasogastric (NG) tube. This tube is placed down the nose and through the esophagus into the stomach. It is smaller than a respirator tube. Although it is possible to talk, the tube in the throat can make talking and swallowing uncomfortable. High calorie liquid foods are delivered through the tube. Other types of artificial feeding methods include IVs (intravenous tubes) or a tube placed through the belly wall into the stomach.
Cardiopulmonary Resuscitation (CPR)
If your heart or breathing stops while in the hospital, an emergency team begins CPR to start your heart and lungs. CPR is tried unless you and your doctor have previously given orders not to have this done.
For CPR, a crash cart with equipment and drugs to revive the heart and lungs is quickly brought into the room. Paddles that supply an electrical current through the chest to the heart and intravenous medications may be used to start the heart beating again. If this does not work, the emergency team starts pumping on the chest and using artificial respiration. The forceful pumping may cause pain later. Attempts to revive the heart continue until the heart starts beating again or the doctor believes additional efforts are useless.
Sometimes CPR can last over an hour. The longer CPR is given, the less likely it will be successful. It is possible for very ill patients to have CPR administered several times in one day. After the heart starts beating again, patients often need to be on a respirator for a few hours or days.
Antibiotics Serious infections, such as some kinds of pneumonia, are sometimes referred to as “the old person’s friend.” Untreated, they can bring a fairly comfortable death within a short time. Massive doses of antibiotics can cure a serious infection, but the underlying health problems are not affected. Discomfort resulting from a serious infection may be eased by a cooling blanket for fever, oxygen for shortness of breath and medications for fever or pain.
If your kidneys fail or function poorly, your doctor may recommend dialysis. Dialysis consists of inserting large IVs, usually into the arm or groin, and attaching them to a portable machine that cleanses the blood of toxins and removes excess fluid the kidneys are not able to flush.
This is a procedure that can be either short or long term. While dialysis does not cure the underlying condition, it can assume kidney function for the body while the kidneys have time to recover. If kidney function returns, dialysis can be discontinued. If the kidneys do not recover, the patient may always need to rely on dialysis. Dialysis generally takes two or three hours and may be needed three times a week or as often as every day.
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