Sock Puppets Not Included

Had another one of those interminable discussion with a patient’s son about advance directives that started by him saying, “I don’t want anything done, just want a little shock for her.”

Oy. “A little shock” — defibrillation — is never as simple as just plugging in the zapper and pushing the red button. Oh no. You have to do other things, like CPR, and ventilation and drugs. There isn’t actually much point in defibrillating, except maybe the quickly passing sense of actually doing something for the patient, without the chest compressions, the drugs and the ventilation. There is no such thing as non-invasive Acute Cardiac Life Support.

All of which I explained to him in careful, excruciatingly painful detail, careful not to use words of greater than two syllables nor technical jargonese.The son, God bless him, was attentive and serious, but clearly out of his depth. Round and round we went. He asked questions. I answered as clearly as possible. I used every technique short of interpretative dance and sock puppets.

In the end, I’m not sure if he even vaguely understood anything at all, except he decided his father should be a full code.*

Maybe I should’ve used the sock puppets. With the interpretive dance.


*That is, do every and all heroic measures.


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  1. #1 by Lisa on Saturday 19 June 2010 - 1016

    did he think you were suggesting those things be done since you took so much time to explain them?
    sometimes it is hard to say no once you know what is available.
    I feel like perhaps advance directives should be a required course in high school :)

  2. #2 by skdadl on Saturday 19 June 2010 - 1134

    It’s not always so clear what the pros are telling us, though.

    As the PA for my husband in the last stages of his Alzheimer’s, I had talked over several months to a half-dozen doctors I greatly respected about the inevitable proposal of a feeding-tube that would arise, and I’d made my peace with the decision to stop short of that measure. Then suddenly, in crisis, I ran into two doctors, not just one but two, who really challenged my decision. Horrible experience at a very hard time for the two of us. It happens.

  3. #3 by wilomis on Sunday 20 June 2010 - 1201

    but it always looks so cool on TV….

  4. #4 by Loretta Downs on Monday 21 June 2010 - 1234

    It is agonizing to be in the position to have to make a decision to allow a loved one to die.

    Having been in many ERs with many different friends and family, it is a traumatic experience that never gets easier. Each person comes with a unique set of experiences, beliefs and values silently screaming to be heard.

    That noise, added to the cacophony of voices and machines and doors and sirens and cries that fill the ER produce a discordant symphony of suffering that blocks out all but the sound of fear and hope battling in the heads of the patients and their loved ones.

    We need to be planning ahead for these experiences. We need to be talking about end-of-life decisions when we are healthy, and at each and every turning point in our lives. We need to know what it means to be shocked. We need our doctors to be helping us to do this so that the sons and daughters, all the decision-makers at the bedside of a loved one will hear the right music and know the words to the song.

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