Monday, August 24, 2009

TPA Commentary

When I put up the TPA post (see below) the last thing that ever occurred to me was that it would spark discussions in families about advance directives and TPA.

But, from reading your comments, obviously it has done so.

I consider this a good thing. Hopefully you'll never be in the situation below, but I think it's good to have talked about it in advance, so those who may have to make decisions for you know what you would want.

Dr. Grumpy.


Anonymous said...

My husband is Mr Indecision. I just emailed a link to your TPA story for my sons to read. I gave it the title Do Not Let This Happen to Me

Anonymous said...

You know, even with advance directives, it is not always a simple process.

A dear friend of mine just spent 30+ days in the hospital She is a survivor of colorectal cancer. She also has COPD.

She has one son who is in charge of her care when she is unable to do so.

What put her in the hospital was a lower GI bleed. After this last surgery, she made her son promise not to allow the doctor to give her a colostomy (she had one when the colon cancer was discovered and has since had it reversed). Her thinking was that the COPD is such a burden, she did not want to have the additonal health burden of a colostomy again. She felt her independent life would just dwindle down to nothing and she did not want that for herself at 67.

Well, a week post surgery, she was unconscious because of an infection. The doctor told my friend's son that if they did nothing, she would live maybe a week and die of sepsis.

The surgeon gave her a 25% chance of surviving surgery.

The son, who just couldn't bear the thought of having his mother die when there was a chance to save her, allowed the surgery.

Now my friend not only has a colostomy, but a feeding tube because she has lost so much small bowel.

Quality of life is a real issue for her now. She survived the surgery and is now in rehab in hopes of getting strong enough to go home.

I have never seen her so down. When I talked to her today, she said, "Too much is broken."

I would never want to be in the position my friend's son found himself in. What a horrible choice.

Even with an advance directive in place that the family knows about and agrees to...well, it can be an impossible choice like this.

But, an advance directive is surely better than nothing.


Jeni said...

Hmmm. Do you realize -or do people who read this post and TPA, etc., who take action for advanced directives realize this is basically the same as the conversation held when people are admitted to the hospital and is often being label as "Death plans" by those opposed to health care reform?
Knowledge -and that is what this type of planning - advanced directives, etc., -is and it is not something bad but helps the patient, the physician and also the family at a time when clear thinking may not be present!
Thanks to you for posting about the response your other post received!

S3XinthePantry said...

I agree! Advanced directives - as detailed as possible.

Lilorfnannie said...

I just read this entry & the one previous. Wow- :-/ That would be really really hard to watch!!!

I have neighbors that sound like those two. They are both older and have health issues. The husband has serious health issues and is on oxygen, can't get up unassisted if he falls, and uses a cane. The wife, I don't know what her health issues are, but she is obviously frail, semi-shuffles when she walks, and there is a 1-2 second lag whenever she responds to something I say. She doesn't seem to be able to follow complicated conversations either, it has to be simple. She is virtually incapable of making decisions, and has burst into tears on occasion telling me that things are hard to deal with. I guess hubby is grouchy and doesn't have patience with her timidity. I think they spend most of their time in the house watching tv (I don't think they have hobbies either) and going to doctors' appointments, I've only heard of the wife visiting friends for lunch a time or maybe two but hopefully it is more than that- but I rarely see anyone visit them. Their only child is two states away and did I mention the winters are icy and they live in a house with stairs that they haven't been able to sell, at least not for the price they want....I do what I can for them but they are too proud to let me do much. Anyway they kind of sound like your patient & his wife.

Anonymous said...

My friend had this talk with me, she's 62 years old and has already suffered a stroke a few years ago that nobody caught for a long time. She has 2 daughters who are around 40 years old who are very selfish, she's scared they would pull the plug just to go get dinner early. So she asked me if I would take her power of attornery if anything ever happens to her, and she told me in details what she wants and doesnt want if anything happens. And she also made it perfectly clear that I dont let her daughters convince me otherwise. And I'm only 26 years old, and she trusts me with her life more then her own family, she thinks her daughters would do the same thing that crazy lady did.

Wunderwoman said...

Thank you, I am studying for my NCLEX and after reading your blog I got a question right!! Yeah...

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