Amy Gets It Right

I am not an avid reader of Dear Amy in the newspaper; however, I found today's column to be very appropriate for what we are trying to accomplish in health care today.  A woman wrote that her father, who is 91 and suffering from dementia, gave his son a living will a few years ago.  Under the circumstances, the son wants to fulfill his father's wishes by exercising the no heroic measures component of the Living Will.  The daughter wants to fulfill her mother's wishes, as she would like any measure necessary to resuscitate her father be exercised because the mother, who is of sound mind, will miss her husband terribly.  Amy's response was right on target; fulfill the wishes of the individual.  Why put someone through those heroic measures when they have no chance of any quality of life? 

Recently, my family experienced the same issue with a out-of-state distant relative who made his peace and said that he was ready to die. Unfortunately, the family hadn't conveyed his wishes to the staff.  Once he went into cardiac arrest and since he hadn't completed a do-not-resuscitate order, he was resuscitated.  Fortunately, his family finally got it and conveyed his wishes.  He died shortly thereafter.  

I just wish the family had that same "a ha" moment when their father was first hospitalized after a fall.  He was eventually transferred to a skilled nursing facility (SNF) from the hospital with two pretty significant pressure ulcers that only worsened at the SNF along with the addition of several other ulcers.  There was very little attention paid to the pressure ulcers with little care, treatment or wound therapy.   In addition, he was rarely ambulated by the staff.  The staff was pleased with themselves when they got him to sit in the chair.  When the family was asked about why they weren't more adamant about the care of their father, they said that the staff are working so hard as it is.  Yikes!  I can't imagine letting someone deteriorate right before your very eyes and not advocate for your loved one.  Between the pressure ulcers, the lack of ambulation and the meds that he was on, the entire scenario can be described in one word: iatrogenic.  His condition and subsequent deterioration were the direct result of an inadvertent lack of care brought on by medical professionals since his goal was to walk out of the hospital after that April fall.  It is so very sad in that there were so many who could have advocated for this man but didn't.