When Something Has Happened We’d All Prefer Not: My Advance Directives In case of a Sudden Life Threatening Event

[Timothy Boon, RN, is the CEO of Good Shepherd Community Care (GSCC) in Newton, MA. GSCC is an independent, community-based, not-for-profit, non-sectarian, hospice care agency, the first organized in Massachusetts 40 years ago. Recently, he wrote a poem in the style of Dr. Seuss, and recited it on video for ZDoggMD (otherwise known as Dr. Zubin Damania, Founder of Turntable Health, a direct primary care clinic in downtown Las Vegas). The poem is posted here by permission of the author. The video is posted courtesy of ZDoggMD.]

 

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When Something Has Happened We’d All Prefer Not:

My Advance Directives In case of a Sudden Life Threatening Event

Dear family and friends and whom it may concern

I’m writing this poem to help you discern

The actions to take and the things to refuse

When some terrible day you are faced with the news

That some sudden illness or stroke of bad luck

Has left me unconscious and helpless and stuck

face-up in an ER,

laid out on a stretcher

With chaos around and you’re under pressure

To make some very quick, high-stakes decision

I want you to feel you at least have a vision

Of what you can do, so you’ll know in your soul

That you’ve done what you could with what’s in your control.

 

There are so many things that could happen to me

From a normal disease to some strange tragedy

I could be shot,

Stabbed or bombed by a

crazed mass attacker

Or do something as simple as choke on a cracker

If I was much older or already quite sick

I’d review what I do and I don’t want right quick

But while in what I think is a good state of health

(barring malignancies lurking in stealth)

It’s a bit more complex than would otherwise be

Were I now gravely ill and you were my trustee

 

If I suffered already some known bad condition

Like terminal cancer for which a physician

Had given a very poor,

sad, short prognosis

Like a bile duct tumor or gliomatosis,

PPMS or an end-stage cirrhosis

I’d choose my own plan for my own diagnosis.

If my heart

were about

to give out

and I knew it

I’d save you this trouble and write my way through it

I’d sit down with my Doc, if she’d sit down with me

And we’d write out the orders for all docs to see

 

It would be what in most states is known as a POLST form

In our Commonwealth we call it a MOLST form

 

We’d talk about tubes for food and hydration

For breathing and peeing and resuscitation

She’d find out when I’d want to be hospitalized

And without much ado it would be finalized

After all of my preferences I have confided

And my doc has checked off all the things we’ve decided

About what I do and I don’t want provided

We’d print out both pages, one sheet, double-sided.

 

We’d sign with a pen, in blue or black ink

And the paper would be Astrobright’s® Pulsar Pink™

 

But that’s not how it is, nor how it may be

When someday you stand looking down sadly at me

When something has happened we’d all prefer not

When I’m mauled by a bear

or a nasty blood clot

Has wedged its way into my heart or my brain

And my pulse or my breathing I cannot maintain

Without all the people, machines and the meds

In this room with us now with the Clinitron® beds

 

At this point you’re proxy, and I am unable

To speak or to write because I am unstable

What I advise now is you try to keep steady

They’ll understand here that nobody’s ready

to see what you’ll see and to hear what they’ll say

You’ll need to stay strong to get through this day.

 

In these first hours, before they know much

There’s no need to talk about hospice and such

I’d like pretty much everything under the sun

To keep me alive till assessments are done

 

But that’s where it gets hard, those assessments are key

To know well exactly what’s happening to me

 

You’ll remember, dear Julie, from your nursing classes,

And know things are bad when they mention blood gases.

When they work fast, but talk to you slow as molasses

To tell you my PCO2 count surpasses

The level at which any life can sustain

And they’ve just placed a catheter in a large vein

And they tell you inserting a tube down my throat

And pumping in air is the best antidote

To whatever initial tests tell them assails me

Let them do it but know

that it won’t cure what ails me

 

Keep in mind

all the time,

that there’s really no doubt

That whatever’s put in

we can make them pull out.

 

If its Day Two or Day Three and there’s been no real changes

If we’ve not gotten past keeping vitals in ranges

That keep me alive and my organs perfused

And my mental state’s worse than just simply confused

And I’m still not able to talk, think or write

It’s time to get serious bout how long to fight

 

Now’s when you’ll have to deal with the odds and the chances

And get all the intel on my circumstances

Make sure all the docs are real honest with you

And they’ve given a total and thorough review

That will help make it clear

what you think

I would do

 

If there’s a good chance I’ll emerge from this coma

With nothing so bad as a limp or a stoma

Then tell them to go ahead with their bad selves

and flitter around me like magical elves.

And poke me and prod me and turn me about

And shove in more tubes from my tail to my snout.

 

But it must be a GOOD chance,

don’t take a long shot

To find out for sure, get a palliative consult

 

You’ll want a clinician who’s skilled in the art

And who’s taken the time to review my whole chart

You need him or her to be truthful with you

To share data and odds and to talk the thing through.

So, review all the facts,

don’t get too sentimental

Save that for the funeral,

I won’t be judgmental

If the life that I’ve lived is now fully behind me

That’s what I want, in the end, to define me.

I don’t want the mem-ory of me recalled

As an oblivious lump with devices installed

And I damn sure don’t want all the money I’ve saved

To be spent on my trip from this bed to that grave

I’d rather you  have it,

the kids and their spouses

If Bernie had won it could help them buy houses

Because he did not and they’re gonna need knowledge

You can set it aside to help them with college

But I guess I’ve digressed,

that stuff’s all in my Will

Let’s get back on the track and get you up this hill.

 

If the odds don’t look good, please don’t grasp at faint straws

Tell my kids, friends and mother — and my in-laws

To gather and for just a moment take pause

Tell me you love me and give me a kiss

Have them turn off the things that buzz, whirl and hiss

Have the nurse give me meds to make sure I feel good

And pull the tubes out, knowing it’s understood

That you were first rate

in a tough situation

You have only my love and my firm affirmation

And my trust you’ve performed, as in past situations,

In a way that’s exceeded my best expectations.

—————————————————————————————–

 

Oh, One last thing………………………..

Before you commence your official bereavement

Could you see if the hospital has an agreement

To do Hospice Inpatient-  at my bedside?

It’s just, .. if it got around that I died

And wasn’t on hospice, I’d be quite mortified.