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EDITOR'S NOTE: This marks the debut of a monthly column by Sonoma County doctor Stacey M. Kerr, who was in private practice in family medicine and obstetrics in Santa Rosa until 2004. She will write about health care issues and developments in medicine.

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It was a rainy spring night in Sonoma County and we were a group of 12, sitting around the fire with some good wine, eating great food, laughing and discussing the hot issues of the day. Some of us were old friends with years of history together; some had walked in as relative strangers but now felt comfortable sharing this evening with new friends.

Stopping to listen to random words in the conversations around me, I heard discussions of respirators, feeding tubes and ``persistent vegetative states'' -- not unusual talk for a party with doctors in the house. But this night was different. The respirators and feeding tubes we talked about were our own. This was an Advance Health Care Directives party -- a group of friends who, until now, had never managed to make our own dying requests known.

Many of us had tried before. We knew the importance of advance directives. All but four of us in the room work in health care; six of us are family physicians, one a hospice nurse. But it is not an easy task. These are not pleasant possibilities to consider. It was always easier to find something else to do, to rationalize that there was time -- there would be time -- later.

We knew the pain of having to make difficult decisions for our patients and their families without the documents to support us. We give these forms to our patients, encouraging them to fill them out and return them so we can have a copy in their chart.

We are grateful when they do; we want that document to refer to if and when they are no longer able to speak for themselves.

But we had never filled one out for ourselves.

Most of us chose not to have our life prolonged in a persistent vegetative state. Although that is one of the options on the form, we wanted to allow our loved ones to care for us in dignity during our final hours and to let us go in peace. We shared what we knew about the physiology of a dying person. We talked animatedly about dehydration and starvation; it is not a painful or horrible death, as imagined by many who have not cared for the dying. The more we talked, the easier it was for each of us to imagine the unimaginable, and to make an informed choice about directing our own end-of-life care.

Planning a party like this and filling out the forms is not difficult, but it does require a bit of preparation. You don't need a doctor or a lawyer at your party, but you do want to have family and friends present. The most important part of the process is talking to the key people in your life, because without this discussion the most complete form in the world may not be helpful.

Basic information and forms are available at the California Coalition for Compassionate Care Web site, www.finalchoices.org. Print out the basic info/fact sheet and enough copies of the advance directive for each guest, and plan on going over the basic information with everyone together before filling out the forms. You also could consider specific topics for discussion. Each guest might want to speak their thoughts out loud -- for their own clarification and so they are clearly understood by others.

We chose to spend time discussing the traits of a good health care agent, settling on these qualities: someone who is close to you, aware of your beliefs and values, and willing and capable of making the needed decisions. Your group may have other important issues that are unique and relevant to them.

As we left the party, we hugged goodbye and reminded each other to be careful out there. None of us wants to have to use our advance directives, but we're glad we have them now.

The physicians in your community urge you to make your wishes known. Use the form easily obtained online, from your local hospital or from your physician. Give a completed copy to your health care agent and to your primary care physician. If the time comes to use it, this document will give you and your loved ones some measure of control, and of peace.

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Longtime Sonoma County physician Stacey Kerr, a graduate of UC Davis Medical School, is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hands-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. Reader comments can be e-mailed to drkerr@the-doctors-inn.com.

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