Welcome back Dr. Barry Pascal, with the second installment in his self-anointed “Death Triology”—his usual funny take on a serious subject: arranging for end of life care, proving yet again that your friendly neighborhood pharmacist–even if retired–is the most overlooked and undervalued resource in our health care system. (As a gentile, I’m not qualified to say whether his also being a neurotic Jew is a value-added proposition.) You can find Barry‘s humorous works for sale here.–EGF
Some Final Instructions
By BARRY PASCAL, Pharm.D.
Humorist, Satirist, and All-Around Nice Guy
I was afraid that my previous article about my writing my own epitaph on my headstone would touch a nerve. Some of my friends, of course, got squeamish and said things like, “Maybe that would make a good horror story or Halloween article.” Or simply, “Boy, are you sick!” Several even started sending me suggestions on what to do with my headstone—before I die.
Wait until you read this one.
However, this process uncovered an important issue for me—my End of Life Care. Now, usually this is not a topic for a humorous article—unless, of course, you are running for some political office. (Politicians treat everything as a joke—it’s not the content that counts, it’s the smile that’s important.) At any rate, most people finalize their Advance Health Care Directive when they go to their attorneys to complete their Living Trusts and/or Wills. I found out that there are a few kinds of End of Life (EOL) directives.
Although I am not an attorney (I didn’t even play one on TV) and can only simplify or generalize these legal documents, I believe the Advance Directive contains general instructions to medical personnel and legal representatives about what actions should or should not be taken when one can no longer make those decisions due to illness or incapacity. There are many other legal instructions, such as declaring a power of attorney, appointing a health care proxy, etc. The “Five Wishes” concept from Florida also seems like a good idea, since it covers the treatment and representative issue, as well as comfort care, personal, and final wishes.
Without these declarations we all know what would and probably does happen. With no declarations, the kid or sibling you were the hardest on will jump up and say, “Let me call these final shots—I know exactly what I want you to do to this so and so.” I can even envision an ex-spouse or two jumping in declaring, “I can handle this—maybe I will finally get even.” If there is no family there, I would suspect the physician whose bill you refused to pay a few years ago would volunteer to handle your case—no doubt with final restitution in mind. You don’t have to be a rocket scientist to see that these documents are really necessary.
I recently became aware of California’s POLST form—short for “Physician Orders for Life-Sustaining Treatment—which deals with specific care and management issues during a medical crisis. The POLST is a medical order, which is signed by a physician and the patient or a legal representative. This form differs from the other medical directives in that it is a physician’s order and is more specific as to the type of critical care that is to be provided at appropriate times. In addition, POLSTs are usually on pink paper.
I am planning on adding a few sections to my POLST. First of all, I want fresh baked chocolate chip cookies on a table near my head. Nothing can bring a person back from the brink like the smell of freshly-baked chocolate chip cookies. Next, I want a glass of whole milk—this would not be the time to worry about non-fat, 2%, or skim. I am also requesting an ice cream dispenser in my room and I do not want fat free, low fat, reduced fat, “lite,” or dietetic either. I want the full 16% or greater butterfat premium stuff. Since a POLST allows one to be specific, I want only Chocolate Chip, Chunky Monkey, and Maple Syrup with Bacon flavors. If I can’t swallow or I am on a feeding tube, I want it warmed up and dripped in all day long. In addition, I want a fresh pastrami on rye from Brent’s Deli in Northridge delivered everyday. If I can’t swallow, I intend to just look at it. I have many more requests, but I have only just started this process and I am working on my list of other important EOL issues. However, the ones listed in this article are the non-negotiables.
Remember, I am not an attorney or an expert in these matters—each of us must do our own research and homework. Find out about these forms and what you need to do so that you will not stick some angry family member or stranger who doesn’t really want to do it with the job of deciding what to do. You know what they always say: “It will not be done right unless you do it yourself…and that includes passing away.
About the Author – Barry Pascal, former North Valley Honorary Mayor and former Honorary Sheriff, owned Northridge Pharmacy for 32 years and is now retired. He has written seven comedy books and writes a humorous column for the California Pharmacists Association Journal, as well as the North Valley Community Connection. He is currently in therapy for nightmares involving choking to death on a handful of dietetic, salt-free Wheat Thins.
© Barry Pascal July 2012