A year ago, my health was deteriorating, and I was struggling to figure out what was wrong. I was steadily losing my ability to walk up any sort of incline, much less a hill. After tinkering with asthma meds and taking a pulmonary function test, I visited my cardiologist. My heart, it seems, was skipping beats and losing its oomph.
I got a pacemaker in June, along with a new Rx for heart failure (the better kind of heart failure, but still not curable). By fall, I was doing pretty well. But when I saw my cardiologist in October, I changed my POLST (Physician Order for Life Sustaining Treatment) form to DNAR (Do Not Attempt Resuscitation) and no-ventilator. Then in January, news of a new coronavirus seeped into the news. As stories began to tell of who was dying from and who was living through this illness, I began to contemplate what care I might want if I became sick.
I’m 75 years old. At this age, my chances of dying from this virus are much higher than for younger people but not as high as for people over 80. I have two strong motivations for wanting to survive if I get sick: My husband is still alive, (I think he needs me); and I want to vote in November. Also, I still really enjoy nature! and friends!
When I changed my POLST form last fall, I was thinking in terms of a heart that does not generate any beats on its own. It’s a dud. I was also thinking of my dad who had heart failure, which is not a nice way to die. Extending my life with machines that are uncomfortable and can’t cure me makes no sense (to me). “AND” (allow natural death) made sense. But now? Even people my age can and do recover from Covid-19.
So yesterday, I discussed this with my primary care doctor. What I want, I think, is to just die if my heart stops, but accept a ventilator (should one be available) if I contract the virus and need it for a period of time. By the end of our conversation, I was more confused than ever. She talked me through various situations where CPR might be successful even for me. And the dividing line between “yes, ventilator” and “no feeding tube” was not as clear as I wanted it to be. Apparently, people who take time to recover might need a feeding tube for some of that time, but they can still recover. I have to wonder what shape they’re in after this experience, but maybe we don’t know that yet.
After a generously long phone appointment, I told my doc that I didn’t know what to do. We didn’t make any changes on my forms, (actually, we can’t because I can’t go in to the clinic for her signature), but she did document our conversation.
I pity the health care workers who would have to try to sort out my wishes if I do get sick. Plan of attack for now: Stay Home, Stay Healthy. There are so many aspects to this pandemic that never crossed my mind before we found ourselves in the middle of it. Plus, we’re still learning how the illness plays out over time, and providers are bravely trying out treatments that might help their patients. I’m fortunate to live in an area that might be flattening the curve already, so our hospitals are not completely overwhelmed (that could change, of course).
Some people find Advanced Directives and POLST forms straightforward, but I’m not one of them. It just seems to me that there are way too many possible health care scenarios to anticipate, and our choices might not be consistent over the various situations. I will say this one thing: if I’m not able to make my own choices, any family and friends who would speak in my stead, No Guilt! You can’t make a “wrong” choice. This just isn’t black and white; right and wrong don’t apply; thanks for being there for me. You’re the best.