The Last Call (Written Dec 25 2018 on Twitter)

Two years ago today, I had to make Gran’s last call. Her nursing home got hit with a wind storm; they were on generator & backup battery power.

She always had a strong living will. We didn’t transport when last stroke hit, per her wishes.

She’d been fine on the Monday before Christmas, and had another cerebral or basal ganglia event overnight, probably the morning of Christmas Eve. But her wishes were no transport to hospital.

I asked for fentanyl & Ativan to keep her comfortable, because she was gone. #Hospice

When you make someone’s last call, and you follow their wishes – no matter what ANYONE else says or thinks – you are helping that person maintain their autonomy and their choices. It’s the most profound kindness and act of love there is.

Medical Orders for Scope of Treatment is the search term you need. Get one of these forms, have it on your phone, email it as needed.

If you’re with your family, today (Christmas!) is a great day to say, “I need to know exactly where your advance directive is. Oh, you don’t have one? Well, I’ll be calling in 2 weeks. Think about exactly what you want. I will follow your orders, but you have to give those orders.”

Loved one says, “but I’m your kid! I’m only 28!” Or “But I’m healthy and will live forever!”

You shrug. Remind them that people get in car accidents and hit by buses ALL THE TIME. Note that it’s more unpleasant to START a family argument by being indecisive than to decide.

Everything gets written down, to the maximum level your state/nation allows. We kept Gran’s 2014 MOST form despite a 2015 update, because she was ADAMANT about no antibiotics once her short-term memory broke. (CO took that off the form for a while.)

Get granular.

(Gran’s? No antibiotics; it’s kinder to die of pneumonia than a slow bladder infection or diabetes. No supplementary nutrition or water if she couldn’t ask for it. No IVs, no CPR, no anything. Drugs for comfort only.)

And make sure it’s signed. Then seal a hard copy in a zip top bag and put it in the freezer door, or in the medications box. You can get an advanced directive sticker from most hospitals. Put it somewhere REALLY visible, so if an EMT has to transport your relative, that form goes with.

I also took copies of her forms to all of the hospitals likely to treat her in an emergency, and had them put in her record.

Because I was not fucking around with the Catholic hospital chain that conveniently “forgets” about the existence of MOST forms & advance directives.

It’s not morbid to talk about how to best die. If it’s an act of love to follow the orders, it’s also a profound act of love to MAKE your own orders.

You tell the people who love you EXACTLY what you want, so they don’t spend the rest of their lives hoping they got it right.