【Late Eye Care】Sign advance medical instructions to avoid disputes

(Hong Kong News) Aunt Zhou passed away peacefully at home after Christmas last year. The funeral service was held in a church in Wanchai. My wife and I were both present. Almost all the people who came to attend were her descendants.

Request to sign a medical order

The memorial service started with looking at some photos of Aunt Chow’s life, from her wedding photos to the recent photo taken with her puppy in front of the Christmas tree. The atmosphere was warm. Everyone seems to be able to find their own figure in the nostalgia. Life can really affect life. Aunt Zhou can always release the energy of perseverance and protection. She is kind and considerate. We have been deeply influenced by her.

The wife’s eulogy has the following paragraph:

“Auntie, thank you. You make us feel respected and trusted.

You showed us what tolerance, understanding, love and confidence are.

We have come all the way, get your unlimited inspiration and support.

Auntie, we are better because of you.

Because of you, we understand the power of being trusted. Nice to have you. Thank you and miss you too! “

My wife and Aunt Zhou’s daughter have been “inseparable” since middle school. You often come to my house and I go to yours. Therefore, my wife and Aunt Zhou are also very close; as for me, since we dated my wife, I also went in and out of Zhou’s house with her many times, so I got to know Aunt Zhou. My aunt is hospitable and kind, and she is a good cook. Her home is also one of our “dining halls”. The friendship between me and my aunt has been close to half a century.

In the summer of 2015, when I was transferred from the Hospital Authority to a private practice, Aunt Zhou specially invited me and my wife to have dinner. As soon as he sat down, the old man said, “Brother Fu, I have a request, I hope you can do it for me.”

Aunt Zhou’s request turned out to be to sign an advance directive for her. Not to mention such a simple request, even if it is more difficult, if I can afford it, I will definitely agree. But at the time, I was a little confused and asked, “Auntie, you are in good health. Why are you so nervous now, and you need to sign the advance directive as soon as possible?”

Make a wish while awake

Aunt Zhou responded, “I’ve seen ghosts and I’m afraid of the dark! I really want to state my wishes when I’m still sober, and I don’t want my children to be embarrassed by me in the future. I saw my husband, your uncle, walk so hard. He is so tall. After multiple blood pressure and strokes, I have to lie down for a long time. In the later stage, I have my stomach throat inserted and wear a breathing mask, and I can’t speak.

“People will always get old, get sick, and die. I may also have a stroke, or be demented, disabled, become demented, and no longer have the ability to express. So, I want to explain everything while I am still sober today. lest I get sick one day At the end, the so-called death is imminent, everyone is arguing because of me, not knowing my intentions, the daughter said, “No matter what, we must rescue my mother, and don’t watch her die in vain”, but the son said, “Grandma hangs her life so hard. , don’t put her stomach in her throat and tie her hands’. It’s inevitable that everyone’s opinions will differ, so I invite you to come here today, hoping to speak clearly in front of my son, daughter-in-law, daughter, son-in-law, two granddaughters and grandson-in-law will.”

I have to admire Aunt Zhou. Although she is over 80 years old, her mind is still so clear. She is always so calm, visionary and considerate of her loved ones. In fact, I have seen many brothers and sisters quarreling over the arrangement of their parents’ Wan Qing’s care. The lack of consensus among family members is often a big taboo in Wan Qing’s care, which will cause greater pain and regret.

Pass away naturally

Aunt Zhou also told us: “My heart has always been bad. Recently, the doctor suggested installing a pacemaker. But the so-called ‘life is time, death is life’, if death is coming, staying alive and lingering is definitely not I wanted to, so I refused. I also want to use today to make it clear: one day, my life is coming to an end, you must not rescue me, don’t beat my chest, don’t help me insert my stomach and throat, and don’t hang a ventilator. In short, Don’t drag me down. Brother Fu, my wish is to ‘pass away naturally, and walk in peace’.”

On the same day, Aunt Zhou signed the advance medical directive under the witness of her family, choosing not to have any life-sustaining treatment at the end of her life. I remember that the atmosphere that night was relaxed and down-to-earth; especially Aunt Zhou, seemed to let go of a stubborn stone in her heart.

In the blink of an eye, it has been more than 7 years. During this period, Aunt Zhou’s health has gradually deteriorated. Abnormal heart rhythm is an old problem. She has also been hospitalized for Parkinson’s disease, femur fracture, and bladder inflammation. But every time she was hospitalized, she would ask, “When can I go home? I am not afraid of death, but I am afraid of going to the hospital.”

Throat intubation required for non-end-of-life patients admitted to hospital

“Going home” is a place of peace and happiness for Aunt Zhou. Her three generations live in a neighboring unit, and she can see her daughters, grandchildren, and even great-grandchildren at home. It is really rare to live a noisy life full of children and grandchildren.

In addition, she also has her own interest in life. Every day, her domestic helper pushes her and the puppy to a nearby park to enjoy the outdoor air, bask in the sun, watch flowers and plants, and listen to the sound of birds. Therefore, she often said: “Being at home is a blessing.”

However, no matter how much we would like to stay at home, sometimes hospitalization is unavoidable. At the end of 2021, Aunt Zhou was sent to the isolation center because she was a close contact with the new crown virus. In November 2022, she was also infected. After being diagnosed, she was rushed to the hospital due to fever, shortness of breath, and a sharp drop in blood oxygen.

Can eat for 3 days at home

Of course, when admitted to the hospital during the epidemic prevention period, family members are not allowed to accompany and visit, and the patient can only rely on the hospital’s notification for all news and medical conditions. Not long after she was admitted to the hospital, her family was notified: “My mother-in-law can’t drink water, can’t take medicine, and can’t urinate. Therefore, the doctor has to insert her stomach and throat to feed medicine, and also insert her urine throat to urinate.”

“Brother Fu, my mother signed the advance medical directive early in the morning, stating that the stomach and throat will not be inserted. What should I do now?” The old friend called me immediately.

Yes, Aunt Zhou did sign the advance directive stating that no life-sustaining treatment will be given at the end of her life. But the key point is: my aunt is not at the end of her life now, but oral medicine cannot be taken. If the disease can be cured through the stomach and throat, treatment is necessary. When the condition improved and she was able to feed herself, we had to remove the patient’s stomach and throat.

Sure enough, the gastro-throat was effective. Within a week, the hospital notified Aunt Zhou that the virus level had dropped to a safe level, and the blood oxygen level was also roughly normal. We immediately applied to the hospital for Aunt Zhou to go home for treatment. The hospital finally approved it, but the patient still needs to be isolated for an additional 7 days and deal with stomach and urine throat at home.

Nurture your loved ones at home

The old man is really upbeat, and he can eat by himself within 3 days after returning home. I removed her stomach throat. After two days, even the pee throat was removed, and after her life at home returned to normal, she was able to go to the park with the puppy even more.

How do I know that good times don’t last forever? Just after Christmas, I received a call again: “Brother Fu, Grandma suddenly has shortness of breath, can’t swallow, and her blood oxygen is very low. What should I do? Should I call 999 and send her to the hospital?”

I rushed to Zhou’s house immediately. This time, Aunt Zhou’s condition was not optimistic; her heart collapsed severely, and the fluid in her lungs made it difficult to breathe. Although her new crown virus was cured, it once caused hypoxemia and accelerated heart failure, which can be said to be in the final stage.

We knew that her condition was irreversible, so we decided to respect the old man’s wishes and not to do any futile rescue. Aunt Zhou was not sent to the emergency room and chose to stay at home. During her dying days, she was always accompanied by her beloved family members. In addition to her daughter, son, daughter-in-law, son-in-law, and granddaughter, her favorite puppy Maru was always by her side.

When Aunt Zhou was still in good health and her mind was still in good spirits, she seriously considered her late care, and let her children and grandchildren know her views and wishes as early as possible. She officially signed an advance directive, a valid legal document for life-sustaining treatment. With this refuge, the family members can safely carry out her wishes at the end of her life, and live and die in peace.

Although everyone is extremely sad about Aunt Zhou’s departure, we are really grateful when we know that she has no worries, no regrets, no pain, fulfilled her wish, and died with a smile. Aunt Zhou’s views on life and death are forward-looking and thorough, and life education is verified by life.

I expect that after the legislative review of advance directives this year, the general public will be able to better understand and promote life choices. It is indeed a blessing to be able to pass away peacefully at home according to one’s wishes. I believe that kindness can really accumulate blessings. Aunt, have a good journey.

Article by Liang Wanfu (geriatrician), Ming Pao

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