What’s Your Exit Strategy From Life?

AnnMarie Q. McIlwain

To hear her talk you would think they were newlyweds, yet it was 63 years since they said their vows.

Two grown children, devoted grandchildren and a marvelous retirement filled with travel to Hawaii and other parts of the world, golf, bowling and great friends. They were blessed.

Then age caught up and at the encouragement of a granddaughter who searched for a patient advocate near New York, I was now with the wife at the hospital, bedside, with her husband who suffered a fall and was unresponsive.

A week in the ICU and all I could see was a handsome man with a beautiful face that must have electrified her heart when he smiled.

While the highly qualified doctors generously spent two hours with us showing us his scans, testing his respiratory function and discussing what ifs, they said his brain bleed was extensive, inoperable, and his potential for recovery was nil.

Encouraged to remove the breathing support, the medical treatment that was keeping him alive, his wife felt like she was being asked to commit murder. Little sleep over the past few days didn’t help any.

Unlike two-thirds of Americans, my client had an advanced directive (aka Living Will) and, with it, he spoke even when he couldn’t. These legally binding documents protect a person from medical interventions that they consider undesirable and guide family members in their decision making, often when they are least able to think clearly.

Sitting at the edge of her husband’s bed, massaging his hand, the physically and emotionally exhausted wife was unable to take in much of the medical jargon and the good intentions of the medical staff. She could not commit herself to a decision.

I asked her if she would like a second opinion outside of the hospital system, something I have done for hundreds of clients, and she said yes.

As a health advocate, I have developed relationships with many doctors around the country. Fortunately, in this case, I knew where to turn.

The Chief of Neurosurgery for the largest hospital system in the state where my client was hospitalized had saved a client of mine who developed a brain tumor four years ago.

As talented as he is kind, the neurosurgeon agreed to speak with my client’s wife. This is a doctor in great demand and who does hire-wire acts in the operating room twice a week. Yet he carved out as much time as my client’s wife needed to address her concerns.

In that conversation, he said “we know how to remove blood from the head, but we don’t know how to restore an injured brain”. Surgery he said, “would only cause harm and pain”. He then went on to say to the anguished wife “you are not making a decision for your husband. He already spoke with his advanced directive and said I don’t want to be kept alive under these circumstances.”

I could almost hear her heart rate relax with these thoughtful words from the doctor. She said she was ready for the family meeting to say goodbye and I notified the treating team. The ICU doctors were relieved because we may be the people talking to the doctors in circumstances like these, but the doctors are required to be mindful of their patient—the person in the hospital bed. Given the patient’s written wishes, doctors are medically and ethically bound to honor them. In this case and perhaps often the case, the physicians wanted an outcome that was sensitive to the patient and his family and they gave us time to process it and get more input. In doing so, it allowed the wife to understand that no decision was required of her. She was relieved of that burden by her husband’s proactiveness.

Ben Franklin was known for precocious wisdom. While we will never know what circumstance Benjamin Franklin was thinking about when he said, “By failing to prepare, you are prepared to fail.” If he were alive today and speaking in a podcast, ala Poor Richard’s Almanac, I can imagine he would offer the practical advice of having an exit strategy.

Protect yourself and spare your loved ones by completing an advanced directive. AARP has the legal forms for every state available online. There is no cost to complete them now other than the emotional kind if you don’t.

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