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Posted by Dr. Lachlan Forrow March 25, 2013 03:51 PM
It took a village, my BIDMC colleague Dr. John Halamka wrote in his blog Life as a Healthcare CIO earlier this month, expressing his "Thank You to the Village" as he concluded a deeply-moving series of reports from the front lines of a family crisis, which began in the middle of the recent blizzard in Boston:
On Friday at noon, I received a call from my father's cardiologist that I should fly to Los Angeles urgently -- "your father has had his third heart attack, his heart is pumping at half its usual volume, and the combination of multiple medical problems requires rapid decision making."20 inches of snow had fallen in Boston on Friday morning, delaying and canceling many flights.The beginning of Spring break meant that just about every Friday flight was oversold to reveling college students...
John's success in somehow getting a flight to LA that night was good luck. The fact that he and his family were at least partly prepared for the crisis was not luck, it was good planning:
Given everything that happened in 2012 -- Kathy's breast cancer, my mother's broken hip, and health issues with my father in law, I declared a family goal to have all wills, trusts, powers of attorney, healthcare proxies, and an open discussion of care preferences by the first week of March. My parents and I worked through a review of their legal documents, an inventory of their preferences, and an accounting of their assets in mid-February so we were well prepared for Friday's events.
As John finds when he arrives at the hospital, "[My father] knows I am here but cannot converse. Today would have been too late to have discussions about his care preferences."
Having had those discussions before it was too late meant that John and his mother knew with confidence that his father would want to "avoid painful, invasive, or aggressive care at a time when his multiple medical issues have combined to make his health decline irreversible." But many specific questions still had to be dealt with -- "Given his low hematocrit, do we give him blood?...Do we give him IV fluids" -- with several decisions that were not clear or obvious at the beginning of the process. Thanks to the skilled help of compassionate staff at the hospital, John and his mother were able to deal with all of these, knowing with confidence that they were being faithful to the overall approach John's father would have wanted.
I urge you to read through each of John's entries, since they so beautifully and richly describe an experience that many, if not most of us, will one day go through. And as John so clearly helps us appreciate, it was not just a matter of trying to make the right medical decisions in the hospital. For example:
How do you find ways to celebrate a loved one's life, when you are holding his hand knowing that he is dying?
What about when the moment of death comes, and there is suddenly lots and lots more to do?
In John's first entry, before he knew what was going to be ahead, he wrote that:
It's an awkward time to post a blog, but if my journey over the next several days with my father encourages others to prepare for these events...my father's life will have made an even greater impact. Making a difference is a great legacy.
John's gratitude in his closing "Thank You to the Village" includes his family, their friends, staff at BIDMC who covered all his meetings and phone calls, and many other colleagues. He cites three "lessons learned":
*Family must come first*There is no work related urgency that trumps a focus on major life events*The people who surround you in life make all the difference
I would add, in my own thanks to John and his family, a fourth:
*We can never be fully prepared, but if enough others who have been there first have shared their stories, then when it comes our turn we will get through okay.
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About the authorLachlan Forrow, MD is Director of Ethics Programs and Director of Palliative Care Programs at Boston's Beth Israel Deaconess Medical Center and Associate Professor of Medicine at Harvard Medical School. More »
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