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A couple of ways to help yourself

Thu, Jul 2nd, 2009
Posted in Commentary

In cases of emergency medical services there is often a degree of confusion even when there are alert knowledgeable relatives and friends at the scene. This is especially true about two things, medications and, to a lesser degree, end of life directives.

Those people on medications of any kind should have a list that is readily available to family and emergency personnel. You should ask your doctor or clinic to print out a list for you. Many departments at Mayo print out such a list routinely and ask the patient to check it for completeness. They normally will be happy to print out a list for you to take home.

It doesn't stop there. You should be sure to add any over the counter medicines such as cough medicine and antihistamines and so forth that you start after the list is made out. You should add the date started and try to remember to cross out the medicine and add the date stopped for all discontinued medicines including over the counter medications.

Place the list in a large envelope and label it with large letters. Use something like red or orange crayon or ink to label it. Use large block letters. You want it to be found easily.

Even if you have a live-in relative or friend, they may not be around when emergency people need to have the information. A good place to put the envelope is taped to the refrigerator. This was recommended when I was doing emergency service run report critiques. and I assume it is still taught to EMTs.

Placing another copy in the medicine chest of the bathroom is also a good idea. I've seen a lot of EMTs and first responders look there for the medicine bottles. People keep nitroglycerine in their pocket and medicines they take more than once daily in the kitchen (sometimes in the strangest places).

If you have someone who is likely to be about and willing to help you, give them a copy as well.

Do not assume you will be able to tell the EMTs about your medications. Even the most sophisticated healthcare worker, when faced with a possible life threatening event, is often not a reliable source.

You should check the list often. When you pay your utility bill each month is a good reminder to think of changing the list if you started a new vitamin or over the counter drug. Every time your doctor orders a new medicine or changes the dose, ask for a new list to be printed.

Medical directives for end of life care seem to create lots of confusion. Their purpose is to name someone to speak for you if you are so sick you cannot make your wishes known. You do not, in Minnesota, need to see an attorney. You do not have to make a new directive every year. You should check it every year (on your birthday?)and date and initial each page.

You do not need to use medical jargon of legalese. You do have to name one or more persons to speak for you and make medical decisions for you if you are unable to do so yourself.

You can list, in your own terms, general conditions and how you want your caregivers to handle those conditions. For instance, you may say in the directive you do not wish your heart to be shocked if it stops or is beating so abnormally it is ineffective. Or, you can say you do not want a tube in your lungs and a machine to breathe for you if there is no reasonable expectation you will leave the hospital and return to your home. You can put in the directive that intravenous fluids are ok but tube feedings into your stomach or intestines is not if there is no reason to believe it would only be temporary.

There are two ways to make it a legal document. You can sign it before a notary and have it notarized. Or you can sign it in front of two witnesses, only one of which can be a healthcare worker or an employee of a healthcare worker who is responsible in any way with your care.

You should give the copy of the directive to your doctor, local EMTs, those you have chosen to speak for you, and family members. You should especially give it to those family members most likely to object to the contents and object to the decisions of your surrogates. It is human nature to resist letting go of those we thought were immortal and are irreplaceable in our lives. This is why so many folks live a miserable, narrow, often painful life at the end of life. Letting go is not euthanasia.

Most importantly, you should have candid conversations with those you name to speak for you. You cannot list all eventualities in the directive. Your surrogates need the conversation to really understand your wants and positions to feel comfortable making the decisions they may be called upon to make.

If you have a computer and access to the internet, the Minnesota Department of Health has a sample form for guidance. It meets Minnesota laws and statutes, which you can also access on the internet if you wish. The laws are found at statutes 145C. The Minnesota Health Department is found at HTTP://health.state.mn.us/divs/fpc/profinfo/advdir.htm.

You do not need to put your directive in the medicine list although you can for the emergency room physicians, if you wish. The EMTs are essentially required to do CPR until their medical control tells them to stop. It is also necessary to understand the emergency room doctor will need time, as will an attending physician, to evaluate the patient and estimate the likely outcome.

A clear medical directive and a good understanding of your wishes by those you choose is the best guarantee your wishes will be followed by your care giver.

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