Dr. Ken Murray’s article about how doctors die generated a lot of comments about the bureaucratic side of end-of-life preparation. Curious to know about a form called the POLST, or Physician Orders for Life-Sustaining Treatment, we contacted a Californian who’s filled one out to explain what was involved. Her account follows.
About a month ago, the last time I had a visit from my home health care nurse, she suggested I fill out a document called the POLST, or Physician Orders for Life-Sustaining Treatment. She gave me the papers to take to my doctor for my next checkup. The document looked familiar. I’ve had surgery several times in the past five years, and I feel as though I’ve filled it out every time I’ve been to the hospital. But POLST is not a standard directive. It’s signed by your doctor, and it’s always in your records, no matter where you’re getting treatment.
I know what overtreatment looks like. My husband died of emphysema 25 years ago. He couldn’t breathe or eat anything on his own, and he was hooked up to the machines for several weeks. It was terrible for me and my family to see him like that, and eventually we got him off the machines.
About six months ago, I got surgery for rectal cancer. Afterwards, I was put on chemo for a few months, as a precaution. Soon the doctors took me off because they said chemo isn’t good for patients over 80 years old. I’m 88. I don’t want to be put on feeding tubes or respirators or anything else to prolong life.
Of course, if you have a really bad bout of pneumonia when you’re my age, sometimes life support machines can get used for a day or two and help pull you through. My doctor told me this as he helped me to fill out the POLST. People as old as I am can sometimes recover–maybe not completely, but at least enough to get around again and see their family. But for me it’s not worth suffering greatly for a small possibility of living a little longer. My POLST form now reflects these personal preferences.
I wouldn’t even have done the chemotherapy at all if I had known better–if I had spoken with my own doctor more when I got the cancer. I later learned he thought it was too drastic for me. But when I was diagnosed I didn’t know anybody else to talk to, so I wound up following the course laid out by the oncologist and the surgeon. It wasn’t that people didn’t give me information, but I was just in such a state after the surgery that I couldn’t absorb it all.
Now, things are clearer to me. The chemo would slightly reduce the risk of cancer returning, but considering how sick it was starting to make me feel it just wasn’t worth it for a person my age. I’m just happy that the surgeons removed everything during surgery and that I’m cancer-free right now. They said I probably have a few good years left in me. That’s not so bad for an 88-year-old woman.
I’m not so afraid of death, but like most people I’d prefer to die in my sleep. What I fear most is having a lot of pain or being put through suffering for only a small chance of recovery. My hope is that having filled out a POLST that reflects my wishes on how to be treated will let me live out the rest of my life as I want–and, one day, die as I want, too.
As told to Antal Neville.
*Photo courtesy of Guillaume Brialon.