Lorri Mostad: Anguished families yearn for ‘advanced directives’

GRAND FORKS — I have been a nurse for 22 years. I have seen death often and discussed end-of-life issues on both the professional and personal level.

But October brought these issues back in a very personal manner. I found myself in an intensive care unit not as a provider, but as the close friend of an elderly woman and her daughter.

My elderly friend was the mother of one of my dearest friends. She was 86 and had multiple chronic health conditions. These conditions had brought about hospitalizations, extended stays in the rehab unit and a gradual decrease in function and quality of life.

She was a proud and independent woman, and although she was failing, she didn’t want to leave her apartment and move into assisted living or a nursing home. But she recently had contracted a pneumonia that resulted in another rehab stay and further deterioration of her overall health.

Despite her family’s urging for assisted care, she returned to her apartment, and the family arranged for a medical alert system. She was put on oxygen, and arrangements were made for a visiting nurse.

Then she fell and broke her hip. When she was found, she was alert; her surgeon discussed the risks of surgery and offered her the chance to complete an advanced directive. This service earlier had been offered to her as well.

But she again refused, saying, “My daughter will know what to do.”

The surgery was done. Initially, she appeared to initially fare well; but then her health began to slide. Clearly, she still was gravely ill, and imaging revealed her pneumonia had not fully resolved. She contracted an infection, was placed on a vent and provided cardiac support.

My girlfriend learned that her mother was not responding well. I arrived shortly thereafter to sit with my two friends.

My girlfriend, also a nurse, was torn as her mother had refused to complete the advanced directive. She recognized that her mother’s condition was compromised, and that it was unlikely she would recover without big hits to her quality of life, prolonged rehabilitation that might not result in full recovery and excessive costs.

My friend and I discussed this as we sat with her mother. Neither of us had easy answers or a crystal ball, but we knew no outcome was likely to be optimal.

During this time, alarms began to sound, and my friend’s mother developed an emergency heart condition. Code Blue was announced, and my girlfriend found herself frantically weighing her emotions against her knowledge as a nurse.

She made an emotionally charged but logical decision and immediately intervened before the full code team arrived.

She told the team, “Stop, this is not what she would want. I can’t let you do this.”

The code was called off, and her mother was allowed to pass in dignity. There was not one member of the team who did not have a look of compassion on their faces. They knew what my friend and I knew: Even though the technology existed which may have supported my dear friend’s beating heart, her life as she knew it never would have the same quality.

Had my friend not been a nurse with a much fuller understanding of the consequences of allowing a full code, her mother’s situation may well have ended with much greater pain, loss of dignity and extreme emotional and financial distress.

We flew her body home to New York to be with her husband. We together buried her knowing more than ever about the need to better educate our peers and our patients on the value of advanced directives and the careful consideration of end of life decisions long before illness clouds our objectivity.

My beautiful friend gave me a lasting gift, which I will pass on in the years to come. That gift is the recognition of the urgency of helping people learn about advanced directives while they are healthy and long before the directives are required.

Mostad is a graduate student in nursing at UND.

Tags: obituaries, updates, health, medicine, lifestyle

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