Letting Go by Charlie Corke

Author:Charlie Corke
Language: eng
Format: epub
Tags: SOC036000, MED050000, MED035000
Publisher: Scribe Publications
Published: 2018-01-29T05:00:00+00:00

Advance directives often give some indication of wishes, but they are often not specific enough, or written recently enough, to provide the degree of confidence that doctors and family need to support a decision to withhold treatment.

This point is well demonstrated by considering the situation of a person who has tattooed ‘Not for CPR’ across their chest. This might seem to be the clearest advance directive possible, indicating that the person really does not want resuscitation.

However, when asked to discuss this case, doctors and nurses readily identify concerns: Could this person have changed their mind, but have been unable to remove the tattoo? (Tattoos are very hard to get off.) Were they properly informed of the current chances of successful resuscitation? Does the tattoo mean they want to exclude resuscitation in all circumstances, even if there is a 100 per cent chance of success?

And finally, of course, to tattoo this on your chest is a rather extreme act. There may be doubt about the sanity and competence of a person who goes this far.

Listening to this concern, it doesn’t take long to appreciate how difficult it is to create a directive that provides the degree of certainly that doctors and family members require to feel confident to act on it.

Knowing a person’s values, how they think, and what gives their life meaning (including things that they would really want to avoid) can support confident medical decision-making.

Let me share an example that happened to me recently:

Madeleine’s story

Madeleine was, and still is, an elderly nurse. I came to know her because of a shared interest in a community group where she is a major force.

Madeleine’s identity was intimately involved in caring for others in need.

Madeleine knew of my interest in planning and had told me she had completed an advance care plan in which she said that she would not want CPR.

I provide emergency cover on occasional weekends at a small hospital in the country town where Madeleine lives (I do it primarily so that the regular GP gets a chance to get away, but it is also very different from my regular job and I enjoy the variety).

It was on one of these weekends that Madeleine was brought in by ambulance. She had severe chest pain, looked ashen, and was sweating profusely.

An ECG promptly revealed that Madeleine was having an acute heart attack — and it looked to be a big one. We quickly administered the appropriate cocktail of clot-busting treatment and everything improved (suggesting that the treatment was working and that blood was again starting to flow down the blocked artery to supply her heart muscle).

As Madeleine improved, her greatest concern, for which she repeatedly apologised, was that she was out in company wearing her old gardening stockings (she had been gardening when she became unwell). She was horrified that she was not dressed more appropriately in public! The stockings looked fine to me, but it mattered to Madeleine.

The next events were rather predictable.

When blood flow is returned to heart

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