A Tale of Two Families

By Robin Lacrimosa, Life Care Coordinator

In another article here on the blog, I wrote about my 14 years as a social worker in an emergency room at one of the hospitals in Athens. If I learned one thing during my stint in the ER, it was this: everyone needs an advance directive. Unfortunately, only one in three people have taken the time to create one.

Two stories stand out as object lessons about what can go wrong when you don’t have an advance directive, and what can go right when you do.

My first example involves Jeff, an 85-year-old man with a host of medical problems, who ended up in my ER one day. Jeff had been ill for a very long time, yet he had never gotten around to creating his advance directive.

Accompanying Jeff to the ER were his four sons, all in their 60s. Two of them lived with Jeff and provided his care. I’ll call them the caregiving sons. Two other sons, who lived about 90 minutes away, rarely stopped by to visit. I’ll call them the distant sons.

The distant sons had stopped for one of their infrequent visits. While they were there, Jeff’s heart stopped. One of the caregiving sons called the EMTs.

When they arrived, the EMTs looked to the children for guidance about whether to start CPR.

“We’re okay with letting him go,” said one of the caregiving sons. The other caregiving son agreed. Both had been there with Jeff for years, day in and day out. They understood his struggle and they knew that he was tired. They had come to peace with what was going to happen.

Not so with the distant sons. They demanded that Jeff be revived.

So, the EMTs, lacking an advance directive, started CPR and continued until they arrived at the emergency room. In the ER, the physicians continued chest compressions. The caregiving sons were adamant. “He didn't want this,” one of them said. The distant sons disagreed. Shouting turned into pushing. Someone called security.

When there’s no advance directive and there is disagreement about what kind of treatment the patient should receive, the ER doctors must determine what to do. This often results in a judgment call. In Jeff’s case, the ER doctors asked all the sons questions about Jeff’s conditions, his medications, his medical history, and more. The caregiving sons easily answered questions that the distant sons could not.

Ultimately, the ER doctor sided with the caregiving sons and opted to suspend treatment. "I'm going to listen to the caregivers who know everything about this man," the ER doctor said. “They want to let him go, so we’re going to let him go.”

The distant sons started shouting. One tried to throw a punch at one of the caregiving sons. Security intervened, and both of the distant sons were escorted out of the ER. They missed the opportunity to be with their dad at his death.

Did the two sets of sons ever heal the resulting rift? I don’t know. What I do know is that those boys said things to each other that can never be unsaid.

Now, contrast the story of Jeff with the story of a family that I’ll call the Talls. There were five children in this family. The shortest one was 6’6”.

Their dad, Elmer, had an advance directive. Elmer was 90 years old and in reasonably good health, though he had suffered a massive heart attack a few years earlier. In this instance, his heart stopped and the EMTs brought him to my ER. All five kids were there. Three of them worked in healthcare, so they understood the odds of survival. They were at peace with letting dad go.

Two of the boys disagreed. "I'm not ready to let dad die,” one of them said. “We still have things to do."

"I have your dad’s advance directive here,” the ER doctor said. “He did not want CPR. We're going to respect your father's wishes and discontinue continue CPR."

The two boys, of course, were very upset because they didn’t want to lose their dad. Yet the advance directive made clear Elmer’s wishes. No one had to guess. “That’s what he wanted, so that’s what we will do,” said one of the boys who had been against suspending CPR.

Once the decision was made, they all gathered around Elmer’s bedside. The chaplain came and we all made a circle, laying hands on him. They sang together, then prayed as Elmer took his last breaths.

I’ll never forget how moving it was. This entire family came together to focus on their father in his final moments of life. After Elmer was gone, I told the family that it was one of the most beautiful experiences I’d ever witnessed in the ER. The Talls’ experience was so different because Elmer had an advance directive. It was nobody's responsibility to decide what treatment he wanted. Elmer had already made that decision.

If you want to create an advance directive, Kimbrough Law can help. Just give the office a call at 706.850.6910 to schedule a consultation.