Mental Illness Awareness Week 2010: October 3-9, 2010 – NAMI is there for you

Mental Illness Awareness Week 2010: October 3-9, 2010

You don’t have to be alone on this journey. Learn more about the full spectrum of programs and services that NAMI provides across the country for people whose lives have been affected by serious mental illness. Go to http://www.nami.org/Template.cfm?section=Find_Support
to find the support you need:

• Center for Excellence
The NAMI Center for Excellence team works to provide NAMI State Organizations and NAMI Affiliates with the the technical assistance, resources and tools they need to build organizational capacity and achieve the goals of the NAMI Standards of Excellence.
• State and Local NAMIs
NAMI’s 1,200 affiliate organizations provide local services, support and other opportunities for consumers and their families.

• Education, Training and Peer Support Center
NAMI offers an array of education and training programs and services for consumers, family members, providers and the general public. These include Family-to-Family, Peer-to-Peer, NAMI Support Group, In Our Own Voice and more.

• Consumer Support
NAMI empowers and educates mental health consumers to address their issues around care, treatment, services, mutual support and consumer rights.

• Child and Adolescent Action Center
Families know all too well that the system is failing children and adolescents with mental illnesses. NAMI created the Child & Adolescent Action Center in response to this crisis, to focus attention on systems reform and to help and support families.

• NAMI on Campus
NAMI on Campus is a network of student-led mental health awareness, education, and advocacy groups tailored to the needs of individual college communities.

• Multicultural Action Center
The Multicultural Action Center focuses attention on system reform to eliminate disparities in mental health care for diverse communities and cultural competence in treatment and support for all who are affected by serious mental illness.

• NAMI Legal Center
The NAMI Legal Center provides lawyer referrals as a service to our members and the general public.

• Veterans Resource Center
NAMI is proud to provide the following resources for veterans and active duty military members, as well as their families, friends, and advocates.

• Missing Persons Support
Resources and support for locating missing persons with mental illness.

• For Providers
To help mental health professionals assist consumers and families further, NAMI has created this section of the NAMI Web site especially for you.

• Information Helpline
Trained volunteers provide information, referrals, and support to all who have questions about or are affected by serious mental illness. Call 1-800-950-NAMI.

Have a kind and respectful day.

Resident’s Rights Week – October 3-9

Defining Dining…It’s About Me
2010 National Residents’ Rights Week: October 3-9, 2010
For more information and resources: http://www.theconsumervoice.org/resident/nursinghome/residents-rights

By Sarah Wells, Executive Director
The National Consumer Voice for Quality Long-Term Care (formerly NCCNHR)

Dining is such an integral, systemic function of our lives that, oftentimes, we may forget how lucky we are to enjoy or share a delicious meal. Many of us are accustomed to eating at any time of the day we desire, with the flexibility of choosing to drive to a five-star restaurant or simply to the grocery store to cook our own meals at home. Often we take these simple everyday pleasures for granted. American culture is based largely on socializing with others during meals, and we expect these meals to look and taste good! For me, dining with family and friends is a favorite activity. While I am not a great cook myself, I am the beneficiary of my husband’s and mother’s kitchen magic!

Residents’ Rights Week 2010 reminds us that long-term care residents deserve the same high-quality dining experience to which the rest of us have access. Individual residents in nursing homes, assisted living, and board and care facilities should have the ability to voice their opinions and be heard when choosing what they eat, when they eat, and the atmosphere in which they dine. The dining experience should be a fun celebration of food, friends, culture and life without invoking a sense of dining in an unfriendly, detached institution.

Residents should be given choices about the kinds of food they eat. This can include having a variety of nutritious and culturally diverse meals prepared throughout the week, as well as meals catered towards vegetarians. It is important to prepare food that residents actually want to eat. Not only should food be tasty and well prepared, but it should be visually appealing as well. Tasty and nutritious foods that appeal to a resident’s sense of sight as well as taste take into account the full dining needs of our long-term care residents.

If residents are forced to eat only at certain times of the day, they may consume food even when they are not hungry – or worse, they will skip meals and not have food available when hunger does set in. Flexible meal times – including an expanded time frame for each meal – are necessary to allow residents to eat when they want. It is imperative that food is available to residents throughout the day, and an option to do this is to offer a canteen within the facility. Another option is to offer room service to residents. Long-term care residents, especially those who sleep during the day and are awake in the evenings and at night, can enjoy the convenience of requesting food to be sent to their room when they feel hungry.

Another area that can benefit from improvement is the way in which food is being served. While many facilities utilize buffet-style and restaurant-style dining for their main meals, more facilities can introduce open access to food in addition to these more established serving styles. Residents may crave snacks when meals are not being served, and this option should be made available to them.

Allowing residents to eat together in a common dining room also enhances the dining experience, and fosters a home-like, friendly atmosphere. This environment should ideally be a well-lit, open area where residents are encouraged to interact with each other. Facilities should also aim to create self-contained living areas for their residents, with each area equipped with a kitchen and dining room. The goal is to permit residents to feel welcome, invited, and safe while enjoying good food and company.

This year’s Residents’ Rights Week theme Defining Dining…It’s About Me challenges us to think of creative ways to implement an exceptional dining experience for our long-term care residents during the week of October 3 – 9, 2010 and throughout the year. If mealtimes are the only event during the day that residents look forward to, which is often the case, then we should strive to give them the best dining experience possible.

As we enter Residents’ Rights Week in October and start thinking about the holiday season – of which an entire day is dedicated to eating deliciously prepared Thanksgiving foods with our loved ones – let’s work together to make 2010 the year to provide our long-term care residents with the tastiest food, comfortable dining environments, and flexible options for mealtimes.

Have a kind and respectful day.

Ryan Whitmore and Michael TS Lindenmayer from The Caregiver Relief Fund, “Providing home health vouchers for care for caregivers in need,” on October 6th, 10AM Pacific on blogtalkradio.com/kindethics

The Caregiver Relief Fund (CRF) is a non-for-profit organization that provides resources, assistance and a voice to over 50 million Americans who are currently caregivers to the chronically ill, aged and disabled. We address two major problems for caregivers: limited time and chronic exhaustion. The CRF provides vouchers for “respite” at-home care, which are donated or purchased on behalf of the CRF from professional at-home care service companies. These vouchers give caregivers time to address their personal needs and grants them the resources needed to invest in their own well being. We created the CRF to respect caregivers, build strong families and ultimately help America face one of its single largest challenges: the aging of America and its impact on caregivers.

How Does The Caregiver Relief Fund Work? The Caregiver Relief Fund begins with leading at-home care companies. We work directly with the individual franchises to secure donated vouchers for “respite” at-home care. In cases where donations are not possible, the CRF may negotiate to buy vouchers to help those caregivers in need. After securing the hours, we will select and match the available relief funds. In order to receive a voucher, caregivers begin by filling out an application form and sharing their caregiving story. Voucher recipients are non-paid caregivers with an annual income of $80,000 or less who have been in a caregiving role for a chronically ill individual, elder or disabled person for 12 months or longer.

Website: www.caregiverrelieffund.org
Facebook: http://www.facebook.com/home.php?#!/pages/Caregiver-Relief-Fund/225706396963?ref=ts
Twitter: Carerelieffund

Michael Lindenmayer: Michael is the founder of the Caregiver Relief Fund. Michael has a long history of building social ventures. He was an early adopter of the award winning leading micro-credit institution, the Grameen Bank (www.grameen-info.org) and of the leading literacy organization, Room to Read (www.roomtoread.org). He is a founding member in the Rio Leadership Institute (www.ilrio.com.br) and of the South Leadership Institute (www.southleadership.com). Michael is a member of the brain trust of World Blu (www.worldblu.com), the thought leader on democratically run organizations. Michael commenced his career in investment banking. He worked at Morgan Stanley in their New York and London offices. He did post-graduate research for James P Womack during his tenure at MIT. He is a frequent speaker on caregiving issues, frequent radio guest and committed champion of caregivers. He graduated cum laude from Kalamazoo College. Michael is a partner in a consulting firm and speaks 5 languages.

Ryan Whitmore: Ryan is the Editor-in-Chief of the Elder Brief (www.elderbrief.com), a publication dedicated to educate and inform elders and caregivers of the products and services available to assist them in their journeys. Prior to his role at Elder Brief, Ryan was a financial analyst based in Chicago. Ryan has served as the co-head of the Chicago Chapter of Room to Read and is an advocate and volunteer for Ladder Up, a Chicago-based non for profit which assists low income families gain access to education funding.
Ryan and his wife live in Chicago. He speaks English and Portuguese.

Join me as I interview Elizabeth Fine from The Memory Tree on October 4th, 9AM Pacific on blogtalkradio.com/kindethics

Elizabeth G. Fine, LCSW is the President and Founder of the Early Alzheimer’s Foundation, Inc and its program The Memory Tree™.

Elizabeth has been working with Alzheimer’s disease individuals and their families for 20 years as part of the staff of Mount Sinai School of Medicine; Alzheimer’s Disease Research Center, Geriatric Psychiatry Department, and also as the Director of the Alzheimer’s Caregivers Program (funded by New York State Department of Health). She has also trained health care providers and caregivers to work with those with memory disorders.

The Memory Tree™ is New York City’s first program solely dedicated to helping individuals with Early Alzheimer’s Disease and their caregivers; in fact, it was one of the first such programs in the nation. The Memory Tree™ is a weekly program providing early intervention, support, respite, and education to a challenged, underserved, significantly growing population. The Memory Tree™ uniquely provides a multi-disciplinary and holistic approach to the challenges of individuals coping with the disease: help for the person who has been diagnosed, intervention for those who have not, and respite for the caregiver.

The Memory Tree™ has grown from a pilot program in Harlem to a program pulling in participants from throughout New York City and the tri-state area. The success of the program is well known with referrals coming from local physicians and hospitals, the Alzheimer’s Association, and word of mouth. The Memory Tree™ opened its second program more than a year ago in collaboration with Dorot Inc in Manhattan’s Upper West Side.

The Memory Tree™ is a not-for-profit 501(c)(3) organization

Our website: www.thememorytree.org
Phone 917-656-0558

The programs meet once a week, and offers a wide variety of classes and workshop which include; Memory Aerobics, Chair Yoga, “In the News” discussions, presentations by the Museum of Modern Art, and group discussions for caregivers, all designed to keep the body and brain challenged.

We offer the program at two locations:

1. Dorot ( 85th Street and Amsterdam Ave)
Tuesdays 1pm – 5pm

2. Morningside Gardens (124th Street and Broadway)
Mondays 3pm – 6pm

September 23rd is Fall Prevention Day – But Fall Prevention Should Be Everyday When Working With Seniors

Falls are the leading cause of fatal injuries for Americans 65 and older. More than 18,000 older Americans die every year because of a fall, and the rate has risen dramatically over the last 10 years.

“When older adults fall, it often leads to a loss of independence, reduced mobility, and earlier admission to a nursing home,” said Lynn Beattie, Vice President of Injury Prevention with the National Council on Aging, and national director of the Falls Free™ Coalition. “But the good news is, through appropriate risk management – falls are preventable.”

Studies show that a combination of interventions can significantly reduce falls in the older adult population. Experts recommend a physical activity regimen with balance, strength training, and flexibility components; consulting with a health professional about getting a fall risk assessment; having medications reviewed periodically, getting eyes checked annually; and making sure the home environment is safe and supportive.

At senior centers across the United States, programs like A Matter of Balance, Tai Chi, and Stepping On help older adults gain the strength, improved balance, and confidence to help them live healthier lives and preserve their independence.

For more information:

http://www.ncoa.org/resources.html?resinterest=falls-prevention&x=115&y=11

http://www.stopfalls.org/FPweek/coalitions.shtml

Have a kind and respectful day.

Viki interviews Dr. Ashley Greenwell and Dr. Plumb, from the VA Salt Lake City Mental Health Services, “Post Traumatic Stress Disorder,” on Sept. 22nd, 12PM Pacific

Join Viki as she interviews Dr. Ashley Greenwell and Dr. Plumb, from the VA Salt Lake City Mental Health Services, “Post Traumatic Stress Disorder,” on Sept. 22nd, 12PM Pacific. blogtalkradio.com/kindethics

Ashley Greenwell, Ph.D. is a VA clinical psychologist specializing in PTSD and readjustment issues for veterans returning from deployments to Iraq and Afghanistan. She began her training in military-related PTSD at the National Center for PTSD in Boston, MA. Following this, she received specialized training at the Salt Lake City VA in neuropsychological assessment of blast-related mild traumatic brain injury as well as evidence-based treatments for combat and sexual trauma PTSD.

Taylor Plumb, Psy.D. is also a VA clinical psychologist specializing in PTSD and readjustment issues for veterans returning from deployments to Iraq and Afghanistan. He completed his pre-doctoral training in the Salt Lake City VA Healthcare System, and went on to complete a Postdoctoral Polytrauma Fellowship focusing on PTSD and Mild-Traumatic Brain Injury in the OEF and OIF populations. His interests are in addressing post-deployment readjustment difficulties, trauma-related sleep problems, and treating PTSD using evidenced based therapies.

National Center for PTSD: http://www.ptsd.va.gov/
National Suicide Hotline: 1800-273-2755

Have a kind and respectful day.

Viki interviews Jennifer Romesser, PsyD, “Traumatic Brain Injury Update-How our military is coping and changing lives.”

Join me as I interview Jennifer Romesser, PsyD, VA Salt Lake City Health Care System, “Traumatic brain injury update – How our military is coping and changing lives,” on Sept. 20th, 9AM Pacific.

http://www.blogtalkradio.com/kindethics/2010/09/20/viki-kind-interviews-jennifer-romesser-psyd-va-salt-lake-city-traumatic-brain-injuries

For more information about combat traumatic brain injuries:

Battlefield TBI: Blast and Aftermath
By Charles J. Ippolito, MD | August 1, 2007

Have a kind and respectful day.

WGNtv.com interviews Viki on the Midday News 9/14/10

Viki will be appearing on the Midday News show on Chicago’s WGN TV on September 14, 2010.

WGN Television, whose call letters are derived from the Chicago Tribune’s first slogan, “World’s Greatest Newspaper”, hit the airwaves on April 5, 1948 on Channel 9 in Chicago from its studios at Tribune Tower.

WGN-TV ushered in a new millennium in 2000 with a new 29,000 sq. ft. state-of-the-art newsroom facility and upgraded digital equipment. In 2004, all Chicago Cubs, White Sox and Bulls home game telecasts on WGN aired in the high definition format on WGN’s Chicago area digital multicast signal, WGN-DT 9.1, making WGN one of the leading HD sports programmers in the country.

2009 marked the completion of full-power U.S. television stations’ transition from analog to digital signals, while “WGN Midday News” and “WGN Evening News” were expanded on WGN-DT 9.1 Chicago, and WGN News merged with CLTV (Tribune Company’s Chicago cable TV news channel). In 2010, WGN-TV became the first Chicago TV station to offer iPhone users the ability to watch live streams of WGN-TV newscasts and “WGN Morning News” expanded to a four-and-a-half-hour newscast. WGN News programs more than 154 hours of news each week (over 44 hours on WGN-DT 9.1 Chicago and 110 hours on CLTV).

WGN-TV has received numerous awards for programming excellence and community service. The station is proud of the many contributions it has made to television, and is recognized as a leader for creativity, innovation, quality programming and integrity in operation.

Have a kind and respectful day.

Avoiding the Pitfalls in CPR/DNR Decision Making

Avoiding the Pitfalls in CPR/DNR Decision Making

Educational Objectives:
Examine the obstacles to good DNR decision making.
Discuss what is CPR and the perceived vs. actual chance for success.
Demonstrate best practices for communicating about CPR.
Consider how the signing of the DNR is just one component of
end-of-life care.

Background:
Older adults and their loved ones are being asked to make difficult end-of-life choices about CPR (cardiopulmonary resuscitation) and its refusal, DNR (do not resuscitate). These decisions are fraught with emotional angst and misinformation. In the past, we only used CPR on patients who were having a heart attack and who might benefit from receiving CPR. Now we use it for everyone, including those in a terminal state, whether it will work or not.

One of the complicating factors is that CPR used to be very simple to understand. Now, the general public doesn’t realize that when the doctor says CPR, she is including medications, intubation and ventilator support. A common misunderstanding occurs when people are given the misleading choice of a “chemical code only.” As nurses and doctors will tell you, if the doctor gives the medicine but doesn’t do the chest compressions to move the blood around, the medicine will not circulate in the body. Without circulation, the medicine can not do its job.

Another factor is that the decision about CPR has inappropriately become an indicator of a person’s complete end-of-life wishes—but the decision about CPR should be only one part of the treatment plan. A patient may want chemotherapy, surgery, radiation therapy or other kinds of aggressive treatments and still may want to be a DNR. Or the person may not want other medical treatments but still want to receive CPR. These are all separate decisions and any combination is possible.

One positive change is that the language of DNR has been modified to “do not attempt resuscitation” (DNAR) or “allow natural death” (AND). Both of these help to clarify the confusion. Do not attempt resuscitation truthfully explains that just because CPR is attempted, doesn’t mean it will work. If you ask healthcare professionals, “How many of you would like to die by CPR?” No one ever, ever raises a hand. What they know, but don’t always share with their patients, is that the chance of CPR working is minimal, sometimes even 0 percent. On television shows like ER, CPR brings the patient back to life about 75 percent of the time (Diem, Lantos and Tulsky 1996), when in real life it only works, at best, 17 percent of the time on healthy patients (Peberdy, et al. 2003). In many real-life situations, the chance of success is zero.

William J. Ehlenbach, MD, lead author of a study of CPR in the elderly, published in the New England Journal of Medicine in 2009, explains, “CPR has the highest likelihood of success when the heart is the reason, as in an ongoing heart attack or a heart rhythm disturbance. If you’re doing well otherwise, CPR will often be successful. But, if you’re in the ICU [intensive care unit] with a serious infection and multiple organ failure, it’s unlikely that CPR will save you” (quote from Gordon 2009; study published by Ehlenbach et al. 2009).

The newest term, allow natural death or AND, is a more gentle way of saying do not resuscitate. Instead of stating what won’t be done for the patient, the doctor is offering to allow the patient a peaceful, natural death and will not attempt resuscitation. Because the CPR/DNR decision is about more than medicine, it frames the dying experience for the patient and the loved ones. For those who are making the CPR/DNR decision, it is important to balance the chances of CPR working and bringing the person back in a good condition with the desire for a good, peaceful and dignified death. This is why healthcare professionals wouldn’t want to die by CPR; there is nothing peaceful or dignified about this type of death.

Case study 1:
Mr. Jackson is a 67 year old gentleman who has end-stage Alzheimer’s, is unable to eat and recently had a feeding tube placed. The patient does not have an advance directive and never told his kids what he would want done and unfortunately, his doctor didn’t ask about his CPR wishes when he was in the early stages of the disease. The physician is now asking, “Would he want CPR?” His adult children have been through a lot over the past years and are overwhelmed by the question. The thoughts running their minds are, “Is it time? Are we giving up? I don’t want to make this choice but I can’t stand watching him suffer any longer. If I make this decision, does that mean I have lost my faith?”

How can the healthcare team help guide the adult children through this decision making process? What are the underlying issues that will make the decision more difficult to make? What statistical information might make the decision easier? What grief support can the healthcare team provide to ease the process?

Discussion – Mr. Jackson:

How can we as aging professionals help those we serve as they struggle with these difficult decisions? One of my roles as a bioethicist is to assist families, like Mr. Jackson’s, who are making the difficult decisions. I am not there to tell the family or healthcare team what to do, but to help those involved to think through the issues so they can make a more informed decision. It is important during these conversations that we keep the patient’s wishes and needs at the forefront.

When working with Mr. Jackson’s son and daughter, I would make sure they are educated about CPR. Hopefully, Mr. Jackson’s doctors will not have eroded the trust and created a confrontational relationship by pushing for the DNR. I would need to be patient as these end-of-life conversations are a process, not a one-time event.

I would make sure Mr. Jackson’s children understand the possible outcomes of CPR. He may survive CPR but never be able to leave the hospital or he may be hooked up to ventilators for the rest of his life. Research has found if CPR is able to bring a patient back to life, the chance of the person going home with good brain function is about 7 percent (Kaldjian, et al. 2009). And in Mr. Jackson’s compromised condition, his chances are even lower. The typical success rate of CPR will depend on the health of the patient, the patient’s age, how quickly the CPR was begun and other medical factors.

Next, I would make sure that the family understood what can happen during CPR. Mr. Jackson may be brought back to life but in a worse condition than before, both mentally and physically. There is a chance of broken ribs, a collapsed lung, damage to the windpipe, and the longer he isn’t able to breathe, the greater the chance for brain damage.

Once the family understands the likely chance of CPR working and what kind of outcomes might be expected, I would then point out that by discussing that by choosing CPR, Mr. Jackson may not have the opportunity for a peaceful and meaningful death experience. I would ask his children, “When your father pictured the last minutes of his life, did he see strangers straddling him on a bed, pushing on his chest, with his family waiting outside his door? Or would your father want his family and friends gathered around his bedside, with words of love being expressed, music being played or prayers being said?” By asking these important questions, I am helping to contextualize the medical choices by explaining what it will be like for their father to experience CPR versus a more peaceful death.

Another common issue I may have to address is to relieve the guilt and angst of those making these difficult decisions. One gift I may be able to give Mr. Jackson’s children is to help them understand that it not really their decision. It is the patient’s decision. I would explain that as the decision makers, they are supposed to consider all that they know about their dad, what he has told them in the past, what his values are, and what would be important to him. Using this information, they should do their best to make the decision they think their father would make.

I would gently ask, “What would your dad be telling us if he were able to understand what has happened? What would your dad say about wanting CPR?” And then I would be quiet and let them sit with the question. In most situations, the family will know the answer but it will be painful for them to verbalize the choice. I would then acknowledge how loving and courageous they are to honor their father’s wishes. No matter what decisions are made, it will be important that this family receive emotional and spiritual support as they struggle with these issues.

Case Study 2:

Mrs. Garcia is an 83 year old woman who has multiple sclerosis. Her advance directive states that she does not want CPR. Her multiple sclerosis has developed to the stage where she has lost the capacity to speak for herself. Her husband is her decision maker and caregiver and he knows her wishes. Last week, Mrs. Garcia suffered a heart attack and is now in the ICU. This morning she coded and was brought back to life by CPR. Her husband has just been called to come to the hospital and was told that his wife survived CPR but her condition is deteriorating. What went wrong? Why wasn’t her DNR honored? What is Mrs. Garcia’s expected outcome after receiving CPR?

Discussion – Mrs. Garcia

What went wrong?

Unfortunately, this scenario happens more often than it should. When Mr. Garcia got the call about his wife, he was shocked and angered. How could this happen?

There are a few possibilities. Some doctors won’t agree to a DNR because of moral opposition and therefore won’t write or respect a DNR. While doctors are allowed to live by their morals and to refuse to participate in acts that go against their values, they are still obligated to let patients know about valid medical options and then let the patient or decision-maker decide. If the doctor is unwilling to do this, then the doctor should help the patient to find another doctor who is willing to talk about the DNR option. If the patient, family or someone from the healthcare team is worried about the patient’s rights being violated, he or she should call for a bioethics consult from the hospital’s bioethics committee.

Another possibility is that the DNR request from her Advance Directive was not transferred onto her hospital chart. If the DNR is not on the chart, it doesn’t exist. Whether you are the patient, the loved one or someone working with the family, make sure you go over the patient’s Advance Directive and other healthcare wishes with the doctor and make sure they are documented.

A final possibility is that medical miscommunication occurred. Perhaps the advance directive wasn’t sent up from the emergency room, the team couldn’t find the DNR, no one took the time to look for it, the on-call physician wasn’t familiar with the patient or numerous other mishaps. As much as the public would like medicine to be perfect, healthcare is significantly flawed and human.

What should happen next?

The first step will be to make sure the DNR order is written immediately. I would hope that apologies would come next. Administration, risk management and other hospital staff will be involved in resolving this situation. This event will be evaluated to determine what caused this medical error and to take steps to make sure it doesn’t happen again. (But it will happen again, but usually not to the same patient.)

Ultimately, the doctor will need to sit down and to talk about where to go from here. Since the CPR was performed, what condition is the patient in? What options are available which would be respectful of Mrs. Garcia’s wishes? Is it time for a hospice referral? The doctor who performed the CPR may not be the best person to handle the situation at this point because of the broken trust. It may be necessary to bring in a different consultant to help bring peace to this situation. It will also be important to address Mr. Garcia’s anger and frustration with the hospital and the healthcare team. He will probably be devastated that his wife’s wishes were not honored and that she is still suffering. Appropriate social services should be brought in to help him with his grief.

Upon evaluation of the event, it appears that it wasn’t that Mrs. Garcia’s wishes weren’t respected, but her wishes were not known (because no one read her advance directive) and the CPR/DNR conversation never occurred. This is also a common problem in healthcare. Many physicians are uncomfortable talking about end-of-life issues. I would hope that healthcare professionals don’t just talk about the medical choice of CPR but would also talk about what kind of life one would want after CPR and what kind of death is desired. The following questions are just as important as, “Do you want CPR?”

Where would the person want to die?
Whom would the person want to be with as he or she dies?
What would bring peace and comfort during the dying process?
For many people, CPR just prolongs the dying process, is this okay?

Conclusion:
The conversation about CPR and other end-of-life decisions is a journey of informing, understanding and helping to support the person who has the difficult choice to make. As professionals, we have to find the courage to walk with our patients as they move through their illness and toward death. As patients and family members, it is important to have these conversations early on and I would encourage everyone to ask for the answers and support you need. If the doctor won’t talk to you, find a doctor who will. And if after talking with the doctor, you realize he won’t respect or support the patient’s wishes, find a doctor who will. Once you have made the decision, write it down and tell others what you would want. Don’t make them guess.

A final thought: I am not saying that people shouldn’t choose to attempt CPR; I just want to make sure patients and their loved ones have the facts about what is CPR, the chance of it working, the kind of condition the person might be in after CPR and the kind of death that is being chosen. Make wise and informed decisions for yourself and for those in your care. Have a kind and respectful day.

Study Questions:
What are the common misunderstandings about CPR?
When talking about DNR, what other issues should be discussed?
What do you think would get in the way of you making a good decision for your loved one?
What decision would you make regarding CPR/DNR and how does that affect how you interact with those you serve?

References
Diem, S. J., J. D. Lantos, and J. A. Tulsky. 1996. Cardiopulmonary resuscitation on television: Miracles and misinformation. New England Journal of Medicine 334 (24): 1578–82.

Ehlenbach, W.J., A.E. Barnato, J.R. Curtis, et al. 2009. Epidemiologic
study of hospital cardiopulmonary resuscitation in the elderly.
New England Journal of Medicine 361 (1): 22–31.

Gordon, S. 2009. CPR Survival Rates for Older People Unchanged.
HealthDay: News for Healthier Living, July 1, 2009.
Kaldjian, L.C., Z.D. Erekson, T.H. Haberle, et al. 2009. Code status discussion and goals of care among hospitalized adults. Journal of
Medical Ethics 35 (6): 338–42.

Peberdy, M.A., W. Kaye, J.P. Ornato, et al. 2003. Cardiopulmonary
resuscitation of adults in the hospital: A report of 14,720 cardiac
arrests from the National Registry of Cardiopulmonary Resuscitation.
Resuscitation 58

Have a kind and respectful day.

If Only Our Pet Could Talk

I think for most pet owners, there are days when we wish we could know what our pet was thinking. This is especially true when it comes to medical decision making. We adopt our pets when they are young and healthy and it doesn’t cross our mind that someday, they might get sick or die. The same thing is true for humans. We want to pretend that we will all live forever.

In my work as a clinical bioethicist, I help families who are struggling to make the right medical and end-of-life decisions for their seriously ill loved ones. I never imagined that I would be having these conversations about my beloved kitty, BooBoo. BooBoo had been living with chronic renal failure for over 9 years. She had outlived every expectation and broken all the records for survival at the vet clinic. This sense of my cat being unstoppable and able to overcome every challenge blinded me to the reality that even a cat, who was a medical miracle, could die.

As her health began to change, certain decisions had to be made. I was lucky because I know how to use one of the tools from my work called the Best Interest Standard. Here is how it works.

Step 1. Ask plenty of questions regarding your pet’s medical condition, treatment options including the option of doing nothing, and the risks and benefits of the different options.

Step 2. Ask quality-of-life questions to understand how your decision will be experienced by your pet.

Step 3. After the decision is made, keep checking in to see how your choice is working. If the decision is not working out, then re-evaluate the situation and make a new decision.

The second step is the step that is often missed. When we ask quality-of-life questions, we are asking what it will feel like for our pet. If your beloved pet has to have surgery, what kind of pain will she be in after the surgery? How long will your pet be in pain? What can be done to make the process easier on your pet?

Here is an example of how I made sure I kept BooBoo’s experience in mind.

The vet said that he could run a special thyroid test to see if she was deficient. It was a simple blood test but before I agreed, I asked, “If she does have a problem with her thyroid, what will you do about it?” The doctor said, “I won’t be able to do anything about it because the medicine that would help her thyroid would harm her kidneys.” So I asked him, “Why put her through the needle stick if it won’t help.” He replied, “Some people just want to know.”

Here is where I had to remind myself that what I might want may not be what is best for my kitty. Sure I would like to know, but I didn’t want to put her through the stress of one more blood test when there was no benefit. When we ask about the risks and benefits we are asking, “What are the good things that could happen from the treatment and what are the bad things that could happen?” This doesn’t mean that we shouldn’t choose the treatment, we just have to be responsible pet owners and to understand there can be bad outcomes.

BooBoo got to a point where she had to have daily sub-cutaneous injections, I had to pill her 5 times a day and her quality of life had deteriorated. The doctor told me that he could put in a feeding tube and I could put all of her fluids and medications down the tube so she her quality of life would improve. No more shoving pills down her mouth or sticking her with a needle. It sounded like a perfect solution. Even though I knew it might not make her live any longer, it would sure improve the quality of her remaining days. So I agreed. Unfortunately, BooBoo had a stroke after the procedure and died a few days later.

Did I make the right decision?

I think I did. I asked lots of questions, thought through my choices and did the best I could. Even though it didn’t turn out right, I have peace of mind knowing I gave her the best quality of life possible. Even when I knew she was dying, instead of leaving her at the vets, I brought her home for the last two days of her life so she could have quality time with me. These were precious moments for both of us. When the end was very near, I returned to the vet so she could have a peaceful end. In life and in death, I did right by her by thinking about her needs first.

For a list of questions you can use when making medical decisions for your pets or your humans, go to the resource page on TheCaregiversPath.com

Have a kind and respectful day.

Next Page »