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| Guest Columnist | Harry M. Covert | Jason Miller | Ken Kellar | Patricia A. Kelly | Cindy A. Rose |


As Long as We Remember...

September 3, 2009

Options: You make the choices

Patricia A. Kelly

They’re everywhere. They’re often small, pale, dressed in out of date clothing. We see them and immediately turn away. “Not me,” we say, “Not me.”


We tell ourselves that we are going to watch what we eat, and exercise. We tell ourselves that will protect us. Not for us the hunched back, the tremulous hand, the walker, the wispy white hair reminiscent of dandelion fluff. Not for us. No way!


We’re going to stay active, and bright, forever.


It would be wonderful if we could control our destiny with our forks and our yoga mats, and we can make a huge difference in our quality of life, but, for most of us, debility is on the horizon.


When we’re young and we hear of an accident or illness, perhaps a limb amputation, we think, “Oh, I would never want to live like that. If I were missing a leg, I would want to die. I could never live in a wheelchair.


The older and more debilitated we get, the more we adjust and find that we place a high value on our lives in spite of physical limitations.


As health care reform looms, we worry that our care will be rationed, that those of us “out to pasture,” will not be valued enough to receive surgery, or high tech, expensive treatment. We want to live. After 40 years of schlepping down I-270 to work, a little Social Security, the early bird special at Bob Evans, that special soap opera, and an occasional home grown tomato sound really good.


When I was 55, I visited a trauma center, and learned that I would, at that age, be considered a geriatric trauma patient. I was shocked! Me? No way!


But I was. My physiology, at 55, made it less likely that I would survive a major trauma, and required special treatment. The same is true, especially later in life, of surgery and other high-tech treatments.


A recently promised deletion provision in the health care bill before congress allowed physician reimbursement for end of life counseling sessions with patients and family. This provision, responsible for sparking fear of “death panels,” actually provides the physician payment for something that already happens, a conversation about expected outcomes and treatment choices.


I’m committed that these choices should be made by the patient or authorized representative, working with the primary doctor, and not by a government body. Ideally, they should be addressed ahead of time in the form of a living will, or through clear direction to family caregivers. This would make a huge difference in quality of life in the last years of life, minimizing worry, discomfort and the waste of many health care dollars.


Think about it. If you were terminally ill, with widespread cancer, advanced emphysema, chronic heart failure, or something else overwhelmingly likely to kill you within the next two years, what kind of care would you want? If you were so sick that you couldn’t walk out to get into the car to go for a ride, how much effort would you want put into prolonging your life?


When would it be prolonging life, and when prolonging death?


There are many options out there. First on my list would be new treatments offering remission or cure. I would certainly ask my physician to keep an eye out for that, and I would look myself. Eventually, though, that option runs out, no matter what strong wishes we have.


Second, and simultaneously, I would attempt to obtain palliative care. It’s a relatively new program that focuses on symptom control for those with chronic medical conditions. Fluid buildup, coughing, and pain are only a few symptoms that can be controlled, while allowing one to pursue other treatments as well. We could all use this.


Third choice, when death is likely within six months, is hospice care. It is essentially the same as palliative care, but designed for those both likely to die within six months and no longer actively seeking a cure for their condition.


Unfortunately, the majority of hospice clients come into the program within a few days of death, minimizing the benefit of months of improved comfort.


People are afraid, thinking Hospice is a death sentence. It’s not. You can resign, or be kicked out at any time if you get better.


As our part of health care reform, we have the responsibility to think about our own choices, and to become educated about our own physical conditions. We should be doing this, and setting up our own treatment plans, before we need them, when we’re at our best, calm and unafraid.


With just a little effort, we can have the power of choice, saving ourselves a lot of discomfort and our system a lot of dollars.


I’d rather die wrapped in a quilt on a breezy porch than strapped to a bed surrounded by blinking lights and little alarm bells. Anytime. Hands down.


Woodsboro - Walkersville Times
The Morning News Express with Bob Miller
The Covert Letter

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