I wake to sleep, and take my waking slow –Theodore Roethke
Tending to Endings (five)
If you have not filled out an advanced directive yet, you will get no judgement from me. I just completed and signed mine this week, January 27, 2020. What finally tipped the scales was not the horrible predicament I would put my family in should I suddenly end up in a coma, but rather the thought of my friends running around looking for my advanced directive saying, “I know there has to be one somewhere. Laura was smart about things! She’s writing blog about this stuff!”
I’m not proud of this. But I include it here in case, you, like me, do not always take care of important things.
I have started the form many times.
In fact, the first time I held an Advanced Directive was after I left the emergency room in 1999. The minivan I had been driving was T-boned by a truck carrying a septic tank. My fault. I had stopped at a two-way and gotten confused on which direction to turn. It was a sunny day on a rural road. I remember there as being no other vehicle in sight—only alfalfa fields and clear skies and the Owyhees in the distance—until I pulled into the intersection and my wrongness slammed into me. Metal crunched and clawed; the world spun; my chest hurt. Powder rose like smoke dancing in shafts of light. I did not know if I was dead. Eventually a cop approached tentatively, fear in his eyes. He didn’t know either.
The other driver and I were, somehow, fine. On the way home from the hospital, I stared at the typed form the receptionist had offered, the words “Living Will” centered at the top beside a rose emblem.
If anyone needed a living will (any will) at that time, it was me. I was going through a divorce. I had preschool-aged twins. Had I ended up brain dead on life support that day, it would’ve been left to my parents and soon-to-be ex-husband to muddle their way through on my behalf. I would not have wished that on any of them.
Two decades later, I finally have an advanced directive.
I contemplate why this has taken so long.
- Fear: Particularly when my kids were young, death was so unthinkable. Making plans for death somehow felt akin to giving my consent. (Denial is a cunning force.)
- Selective Laziness: I have a general dislike for legalities and paperwork. I am much quicker to take on the physical and relational work than the paperwork in pretty much any area of life. (I’ll do yoga and eat well, but procrastinate calling to get health insurance quotes.)
- Ambivalence: I don’t know exactly what I want at the end of my life. How could I? I haven’t been there.
It is this third one that has been the last to fall.
At the last Death Café in Boise someone said, The form is quick. I filled it out in fifteen minutes on my lunch hour.
But when I pull up the forms on Honoring Choices Idaho , the very first question gives me pause: What abilities are so important to you that you cannot imagine life without them? It seems to me a trick question. I’ve learned many times that my imagination is not very accurate in predicting whether I can find peace or joy in various circumstances.
I remember what an ICU nurse once shared, The most important thing is to have a health agent who knows you well enough to interpret and follow your wishes.
This helps me move forward.
My problem was the form was asking me to make black and white decisions for a potential future time in which I knew things were likely to be gray. But I could identify people who I trusted to be flexible thinkers and to know how I might perceive various situations.
Sallie Tisdale, writes, in Advice for Future Corpses, “A friend who knows your values and can handle a crisis is ideal.” I am lucky to have a few to choose from. My husband is my primary, and I add two friends. They are alternates, but they are also people who I know could be helpful to John should he have to make difficult choices.
There are a couple of check boxes asking whether I want CPR or a Feeding Tube or a Ventilator in cases where “Your doctors have determined your illness or injury cannot be cured and death is likely, or your brain function will not return.”
This is pretty clear, and I think I know my answer. Still, I am 55, healthy, and quite fond of living. Before answering, I send the language to a friend who is a nurse along with this question: If I check no to CPR, they will still give me CPR if there is a chance I can recover, right?
It takes her about thirty seconds to respond: Yes, you are absolutely right – the situation only applies if there is no brain function or chance of recovery. The doctors and nurses are very diligent about the certainty of the prognosis.
That gets me through the pick-only-one boxes.
The National Hospice and Palliative Care Organization has templates for advanced directives from each states and a wealth of other resources. And Honoring Choices Idaho offers guides, for the document and also related topics such as dementia and organ donation.
The online resources are extremely helpful, but even more so were the actual conversations I finally had with friends, family, and those with experience in end-of-life care. An advanced directive includes space for comments, nuance, and values. No one could answer these for me, but others could provide context. Our collective experience regarding end-of-life matters is much richer than any one individual’s.
The form took, well, about fifteen minutes. Or twenty years and fifteen minutes depending on how you look at it.
It feels good to print and sign the document. Like any other life decision, this one is made without knowing the future. But I discovered I can influence something that matters a great deal to me if I can lift the burden of those decisions off of my family. Which of course is what people have been saying about end-of-life planning all along.
I take my waking slow. I learn by going where I have to go.
Full text of Theodore Roethke’s villanelle The Waking can be found here and is well worth the read!
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Good job, Laura. Good encouragement as well. Thanks for the resources to make the process easier.
Better late than never…I did mine right after my parents passed to clear up any confusion for my children. Seems it takes something like this to take action. I find it an important document to have as I grow older. Thanks for the beautiful article again.
Oh my goodness Laura, so relatable and so helpful. Thanks for taking the time to write about such an important topic.
Thank you for your honesty and transparency. This document is scary but also so very important.