End-of-Life Care: ER Doctor Answers Our Questionsby The Candid Caregiver
Emergency-room doctor Kevin Haselhorst had an epiphany while he tried valiantly to save an elderly man who’d been through one-too-many traumas. His book, “Wishes To Die For: A Caregiver’s Guide to Advance Care Directives,” was the first step toward a new advocacy. Dr. Haselhorst continues to work toward helping people understand the importance of healthcare directives and the ability to make their own decisions about end-of-life care. Curious about more of Dr. Haselhorst’s views, the Candid Caregiver contacted him through email for the following interview.
The Candid Caregiver: Your book starts out with a vivid description of the scene that, if I’m correct, could be described as life-changing for you. Could you briefly tell our readers what happened?
Dr. Kevin Haselhorst: Life changing, yes! And perhaps a moment of divine intervention. An elderly man with COPD (chronic obstructive pulmonary disease) was rushed to the cardiac cath lab after being diagnosed with an acute myocardial infarction (MI). He was struggling to breathe, yet pleaded with me to not insert the breathing tube and to let him die. The cardiologist was scared to do it. With a voice coming from above saying, “Let My People Go!” I honored the man’s wishes. I tremble every time I read this passage.
This scene was the first time I began to practice what I was reflecting upon while writing “Wishes To Die For.” Particularly how to truly listen to another person’s heart through compassion instead of using a stethoscope.
TCC: In your book, you talked about bracelets that people could wear that could be changed at any moment from “resuscitating” to “do not resuscitate.” I liked this idea because it leaves the patient in control. Do you see a future for this idea?
Dr. H: Medic alert wristbands help first responders know how to act. With a patient near death, paramedics don’t have time to read an advance directive. What they need to know is critical vs. comfort care/hospital vs. home care. The “alpha/omega decision band” is a clear indicator of a patient’s preference. The promotion of this wristband will evolve from patients realizing that their end-of-life care is often harmed by the healthcare industry’s obsession with saving lives.
I tell patients: “There’s strength in holding on and there’s courage in letting go — you can decide which is most important to you (self-determination).” Patients are more apt to allow for natural death after doctors give them permission. – Kevin Haselhorst, ER doctor
TCC: I’d far prefer the language “allow natural death” to “do not resuscitate.” I’m not sure where I first read those words — it may even have been from reading your work. Either way, how do you feel about changing the language used by the medical profession for end-of-life care and do you see that terminology changing any time in the near future?
Dr. H: Developing a common language with precise words is the best form of communication. I recently completed the Advanced Trauma Life Support (ATLS) recertification exam. Words like “trauma resuscitation” and “fluid resuscitation” would not apply to patients with a DNR because “do not resuscitate” only applies to sudden death — not patients near death.
“Do not reverse” nature from taking its course is still a hard pill for most patients and their caregivers to swallow. They rarely think in these terms.
Still, “allow for natural death” is less confusing than DNR. Patients need to remember that actions speak louder than words. Refusing hospitalization, skipping medication and saying “no” to medical procedures are sure ways to “allow natural death.” I tell patients: “There’s strength in holding on and there’s courage in letting go — you can decide which is most important to you (self-determination).” Patients are more apt to allow for natural death after doctors give them permission.
TCC: Your booklet “Is Palliative Care Right for You?” is available on Amazon along with “Wishes To Die for.” Why do you feel that palliative care is so important?
Dr. H: I just read an article that stated the term “palliative care” was coined by the Canadian surgeon, Dr. Balfour Mount, who was looking for a term to describe medical care that would be free of the negative connotations associated with hospice. Elderly patients who prefer not to stay in the hospital and fear the stigma of hospice as “giving up,” need encouragement and support with leaving well enough alone.
Why is palliative care so important? Because I receive a rousing round of support from patients and family caregivers alike when I suggest that we not look for more conditions to treat and simply manage the concerns and symptoms at hand. I might treat a fever with Tylenol and discourage the use of antibiotics. If the patient is not a candidate for brain surgery, I’ll question the need for a CT (computed tomography) scan of the brain after a head injury. Palliative care allows me to practice reassurance medicine rather than defensive medicine. I save a lot of time, money, and anguish through this less-is-more philosophy.
TCC: Everyone has different ideas about what constitutes quality of life but what would you say is a defining time for most people when they feel that they should be allowed to live and die naturally?
Dr. H: I tell patients over age 85 that there are no rules. You no longer have to listen to what the doctor tells you to do. You get to choose. In essence, “You’re free to die naturally if that is your choice.” These words are music to their ears and make their faces light up! It angers me that someone didn’t talk to them about self-determination at the age of 65, it might have spared them a lot of pain and suffering. I often hear stories of patients in nursing homes who survived a cardiac arrest. Did anyone think about their quality of life in the aftermath?
I have a friend whose 92-year-old father was playing tennis three times a week and fell, suffering a brain bleed. He could have died at that moment. Three years later he’s never returned to the tennis court and barely leaves home. Was his quality of life taken into consideration before the surgery was performed to save his life? Does anyone truly wish to depend on others to live?