End-of-life care discussions are crucial

Dr. Margaret Elizondo is a hospice and palliative care expert affiliated with Sharp Grossmont Hospital. A version of this essay was originally published in The San Diego Union-Tribune.

The call came when I was in the right place at the right time. My elderly mother was at a friend’s home for game night in 2021, and I happened to be just down the street. My mom was having a medical issue that would normally send someone to the hospital. Her friend had already called 911, so when I arrived, paramedics were ready to put my mom in the ambulance.

I showed them a copy of my mother’s Physician Orders for Life-Sustaining Treatment form on my phone. It disclosed that my mom did not want resuscitation, nor did she want to go to the hospital.

It took some time persuading the paramedics. However, with my being a physician, and my mother revived enough to confirm that she did not want to go to the hospital, they were eventually convinced. So we managed to get her back home, and I stayed with her that night to see what course of action — including hospice, potentially — would be appropriate in the morning.

My mother turned 97 this year. She’s at a point in life where it may be her last birthday celebration. She’s not sure she wants to make it to another. Though some may see this as morbid, my mother has had a full life and many decades to contemplate her mortality.

She has made it clear that she is not afraid of dying — that it is the natural thing we all must do. She has made it easy on her family to follow her wishes in pursuing a peaceful passing, if at all possible.

Advance health care directives bridge the gap between patients and medical systems
Not everyone is comfortable talking about death. Some people have no experience with the dying process and hope to keep it that way. This “ostrich in the sand” mentality, though, puts loved ones at risk for unnecessary suffering.

Our medical system defaults to prolonging life at all costs unless one strongly advocates otherwise. The medical community still has room to improve training for end-of-life care. In a 2015 University of Florida study, almost 9 in 10 surveyed medical residents reported little to no in-class instruction on end-of-life care, with most end-of-life conversations occurring unsupervised.

Not being trained in end-of-life care may lead to doctors providing inaccurate information, which delays initiation of comfort care, as the end of life approaches. Families may assume doctors know when to stop offering invasive treatments to patients in futile situations, but too often they don’t. And broaching difficult conversations about death is not always top of mind for anyone involved.

That is why documents such as a Physician Orders for Life-Sustaining Treatment form and an advance health care directive can help bridge the gap between the patient and medical system, so that no one is left in the dark on how a patient wishes to be treated in their most vulnerable moments. These documents are designed to be filled out in advance so that when a medical emergency happens, and you are unable to speak for yourself, the forms are there ready to speak for you. In the forms, you can specify the type of treatment you want to receive and who can make decisions for you and express your end-of-life wishes.

Knowing a loved one’s wishes provides strength to carry them out
When my mother had an apparent seizure at her friend’s house that night, it was fortunate that I could intervene. I took her home to her own bed, rather than allow the paramedics to transfer her to the hospital.

Yes, there are lots of things that could have been done to her at the hospital to figure out what was going on. But given that I knew that what mom wanted was to stay home at this point in her life, I got her home. Also, I know that very elderly patients are at much greater risk for complications such as delirium during a hospital stay, which itself increases morbidity and mortality.

My plan was to see how my mom did the next day. If she was still minimally responsive, then I would have made a call to hospice. As it turned out, she recovered back to her baseline, and is still doing relatively well.

I don’t know what is lurking in her body or when she will take a turn for the worse again. But I do know she can be spared the complications involved with hospitalization at her age. Thanks, Mom, for letting me know your wishes, and raising me to have the strength to carry them out.

Learn more about Sharp’s free Advance Care Planning Program.