Dad's Heart Attack: A Personal POLST Story

Dad’s Heart Attack: A Personal POLST Story

An unexpected lesson about the POLST.

“It was a heart attack.” Those are words no one wants to hear. As I sat with my dad this past week in his hospital room, the cardiologist explained the mechanics of what had happened and the course of treatment Dad would follow in the coming weeks as he continues to recover.

My Dad had a heart attack and I had his POLST with me

 

For the past five years, my life’s work has been devoted to helping families prepare for—and talk about—future and end-of-life healthcare decisions. The past week afforded a very personal and poignant reminder of the unexpected nature of a medical crisis.

Thankfully, Dad was fully alert and able to express his wishes. I am even more grateful that Dad and I have had several conversations about end-of-life treatment preferences. In fact, in the past year, Dad has updated his healthcare directives and has written a POLST during a consultation with his physician.

A POLST (Physician Order for Life Sustaining Treatment) is a clinical document that defines the patient’s medical treatment preferences for end-of-life care. A POLST is a crucial type of directive for those who are nearing the end-of-life. Most commonly, the POLST states the doctor’s orders for do-not-resuscitate and do-not-intubate according to the patient’s wishes.

As his healthcare agent, I dutifully arrived at the hospital with copies of his healthcare directives. While I knew his documents were already scanned into his medical record, I also knew that having paper copies handy would be advisable.

Paper copies of your healthcare directive and POLST can be important in a crisis.

That’s one of the points I teach when I speak on healthcare directives—have paper copies of a loved one’s directives with you when you go to the hospital. I even suggest keeping copies in your glove compartment, as you will most likely head to the hospital in a hurry and might forget to grab a folder from home.

Turns out, I was more than right.

I spoke with the first nurse attending to Dad’s care. I explained that I was Dad’s healthcare agent and that I had copies of his documents with me, including his POLST.

She asked, “What’s that?” I was incredulous. I said, “A POLST.” And again she asked, “A what?”

In speaking with the charge nurse, I asked if Dad’s directives were visible within the electronic medical record. He responded, “I don’t know.”

In fairness, the nursing staff at the hospital are out-of-towners, substituting for nurses who are on strike in our local healthcare delivery system. The nursing care was marvelous in so many ways; Dad was effusive in his praise for the nurses who cared for him. Yet, I was stunned that a nurse caring for an 85-year-old patient in a cardiac unit did not know what a POLST was, and that the charge nurse could not find his directives in the electronic medical record.

After I explained the POLST, the nurse replied, “Oh yes… the living will.” Well, not exactly, but she had the right idea. And of course, I offered paper copies to the charge nurse.

Still, my confidence was shaken. What if my father had a subsequent heart attack while in the hospital, and I wasn’t present? His POLST includes a do-not-resuscitate order. Would it be honored?

CPR survival rates are lower than most people realize.

What many people do not realize is the low survival rate for those receiving CPR. Based on 2015 statistics from the American heart association, survival for those suffering a cardiac arrest in the hospital is about 25%, while the rate for those outside the hospital hovers around 10%. For the elderly and those with chronic conditions or underlying health issues, the survival rate is as low as 2%.

What these statistics do not convey is the damage that can occur to the body during CPR—broken ribs, lacerated organs, deep and painful bruising—as well as the resulting quality of life for those who do survive.

In the past year, through the course of a consultation with his physician, Dad at age 85, has concluded that he does not want to endure the pain of CPR and risk the poor outcomes that are likely at his age. That’s why he and his physician completed the POLST and added it to his medical record. I respect his preference, and will do all I can to honor that decision.

Which brings me back to last Sunday at the hospital when the nurse said, “What’s a POLST?”

Lesson learned—be a prepared and proactive healthcare agent. Have paper copies of healthcare directives with you. And, make certain those caring for your loved one clearly understand his preferences and will honor his wishes.

 


READY TO MAKE DECISIONS FOR MOM OR DAD?

You can prepare for the responsibility of serving as the healthcare agent for one or both of your parents. This FREE guide will help you to prepare for the future possibility of making medical and personal care decisions for your Mom or Dad. Interested? Click here to download your copy.
  Healthcare Agent Preparation Guide

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