[Print]Advance Care Plans
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An elderly lady presented and required abdominal surgery. Following surgery she was unable to be weaned from the ventilator. After a long, complicated intensive care unit admission she was transferred to a long-term ventilation unit for a slow-weaning process. Each day she was finding it increasingly difficult to wean from the ventilator. She had a history of severe cardiac disease with gross cardiomyopathy (from which recovery could only be achieved by a heart transplant). Due to her poor cardiac function and respiratory complications she frequently developed Acute Pulmonary Oedema and required emergency medical intervention. This was occurring on average every second day and was becoming increasingly distressing to the patient. Upon meeting her family it was revealed that her elderly husband had Alzheimer’s disease, her son had an intellectual handicap and her eldest son lived a considerable distance from Melbourne. A day after one of her frequent emergency calls she appeared much better but weak and reluctant to wean. The RPC Consultant spoke to her about her feelings, beliefs, values and goals in life. She clearly understood the condition of her heart and was clear about her wishes if her heart stopped. She firmly said she “did not want to be resuscitated”. As the conversation continued she explained what was important to her at this time. She firmly came up with the following list:
The RPC Consultant asked her about a Medical Enduring Power of Attorney, knowing after meeting her family that she was the most appropriate person to make her own decisions. She told the RPC Consultant that any no circumstance did she want her husband "bothered" by making such decisions as he also had a "bad heart" and that she wanted the medical team to make all decisions for her. An allied health meeting was called to discuss the impact of the wishes the patient had expressed about her treatment. The speech therapist (although reluctant at first) accepted that she should be allowed thick drinks, and that the patient was aware that this might cause her to aspirate, develop pneumonia and possibly die as a result. The doctor again talked to the patient for a long time and together the doctor, RPC Consultant and the patient completed the Statement of Choices. After the medical team had gone the RPC Consultant asked the patient ‘if she was unconscious and dying is there anything she would want her family to know?’. She told the RPC Consultant to write, "I love you all very much". She then asked to be left alone. The patient was settled and grateful for the opportunity to express her wishes. She died peacefully 3 days later with her family by her side. |
