Steven M Krawtz, MD

January 25th, 2016

“In this world nothing can be said to be certain, except death and taxes,” said Benjamin Franklin. Tax time is approaching. Most of us discuss our taxes with family, friends, and financial advisors, such that several people are aware of our tax status. And if you are not aware, the IRS will be happy to inform you of your tax status.
couple going over end of life care arrangements

Death also approaches for all of us. You may cheat on your taxes, but you cannot cheat death. Unlike taxes, our ‘drop dead’ day is unknown. Most of us do not think about dying and we are less likely to discuss our death with family members or caregivers. Some of us are given that opportunity, such as with a diagnosis of a terminal disease or steady decline from a chronic illness; however, many people suddenly find themselves critically ill and the possibility of death is front and center. Not so long ago, many people died at home, of natural causes or old age, surrounded by family and friends. Today, if you are sick enough to die, chances are you will be in a hospital, with a diagnosis, surrounded by doctors and nurses.

If you are sick enough to die, one or more of your major organ systems (brain, heart, lung, kidney, liver) are failing in a bad way. You may have a low blood pressure, fast heart rate, be short of breath, in pain, or unconscious. Laboratory tests and radiology studies are abnormal. Most patients and families want ‘everything done.’ Many patients and families expect they will recover and be discharged home. We, as doctors and nurses, want patients to heal and go home, too. Modern medicine is associated with slick surgical procedures, fancy machines, and expensive medications, but sick patients still die despite all of the available technology.

When critically ill, you are typically not able to carry out complex medical decision-making. We, as medical caregivers, will involve family in the decision-making, but they too, because of your illness, are emotionally distressed. It is a difficult time to establish your wishes about the medical care you would want, especially if you have not expressed them to family when you were healthy.

What are some of the illnesses that suddenly result in your death? What does it mean to ‘do everything?’ What decisions can you make and what decisions will your family need to make (about your medical care)? Can you recover from your illness? Is medical care only prolonging your inevitable death? Will CPR be of benefit? What is life support? Can life support be withdrawn?

What is a living will and what does it mean? What is a neuro-vegetative state? What is it like to die?

If you or a loved one is interested in learning more about end of life medical care, I encourage you to attend PMC’s upcoming seminar, End of Life Medical Care. I will host the seminar on Thursday, January 28, 2016 in the PMC Pebble Creek Conference Room. The seminar is free and open to the public. Doors open at 6pm; presentation begins at 6:30p. Seating is limited. To register for this event, call 208-239-1048 to reserve your seat.

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