While at work one day in 2013, I got a call that no one every wants to hear - you dad had a catastrophic stroke, he is in the emergency department at Royal Inland Hospital, Kamloops (I live in Burnaby).
I left work immediately and drove straight there. I found my mom and brother with him. Dad was intubated (tube in his throat, a machine breathing for him, as his brain was so damaged).
As my dad had always talked about the fact that he would never want to be kept alive with breathing machines or a tube giving him food, it was an easier decision to say remove the ventilator.
My mom, brother and I all agreed that is what he would say, so really, we were honouring dad's wishes to not be kept alive by machines. He was extubated and lived for another day and a half. He did not wake up again, but all of us (were able to) say goodbye and adjust to the fact that he was going to die.
Advance Care Planning (ACP) is a process ofthinking about what is important to you, talking with friends/families about it, so that if/when you become sick, your family would be able to know your wishes.
It also involves learing about your medical procedures that may or may not be relevant to your medical conditions.
Next step is deciding: Most people don't realize that during acute illness, they can become delirious, so that the health-care team turns to the substitute decision maker to make decisions on your behalf.
If you have not designated a SDM, there is an order, determined by B.C. law, and you may not want your spouse making your medical decisions.
After thinking, learning, and deciding, you need to talk with your family and health-care team (family doctor, for example).
During this COVID-19 pandemic, we are hearing frequently about the use of ventilators and that there may be a shortage of these.
Ventilators are a great example of a medical intervention that may not benefit everyone (those with underlying medical issues), and many would not want one either.
Let's get families talking about ventilators beyond the living room.
The last step is not done by everyone – record it.
Some people choose to record their preferences on legal documents.
ACP is for all healthy adults – 20-year-olds ride motorbikes, and get catastrophic head injuries; 50-year-olds have strokes, where they can't talk afterwards (but do recover); 60-year-olds get dementia; people at any age can get cancer, which can affect the brain.
I could go on about clinical examples I have seen in my nursing career and personal life. And I know that if people have had conversions with their families in advance, those crucial decisions families have to make during illness that much easier if they have talked in advance.
April 16 is National Advance Care Planning Day in Canada. We can't escape the risk of death, at any time, but we can make it easier for our families and health-care teams.
There is lots of information on this national website:
https://www.advancecareplanning.ca/what-is-advance-care-planning/
In addition, Fraser Health has great information for the public here (and they have a team of people working on ACP in Fraser- with public and healthcare providers)
https://www.fraserhealth.ca/health-topics-a-to-z/advance-care-planning
Nicole Wikjord, RN, MSN, Burnaby
