Welcome to the Light Keepers podcast. I'm Clayton
Vandiver, your Light Keeper, with a show dedicated
to everyone who wants to get the most quality
out of life that they can. My co -host, as always,
is Charlene, our very own licensed clinical social
worker certified in the state of Florida, who
is going to be talking with us this week about
chronic, critical, and terminal. What they mean...
and so much more on this edition of the Light
Keepers Podcast. And before we start, as always,
please leave your questions or comments below.
We will answer them next week on our next edition,
which airs every Wednesday evening at 7 p .m.
Eastern. The Light Keepers podcast is an exclusive
production of A Guiding Light, and we'll tell
you more about A Guiding Light at the end of
the podcast. But right now, we don't have much
time, so let's get right into this week's discussion
about chronic, critical, and terminal. What in
the world do those mean? So those are terms that
are frequently used in medical conversations,
and a lot of times people don't have a full understanding
of the difference between them, and it can be
a little confusing. I'll say I have absolutely
no idea how to define those terms. Let's start
with chronic. What does chronic mean? So chronic
is a condition that doesn't go away. It lingers
and it comes back up and it continues on with
or without treatment. So, for example, arthritis
is a chronic condition. Oh, I can relate to that
one. Okay. A lot of people can. Yes. Okay, so
critical. Critical is when the house cat comes
up during a taping and decides she wants to be
part of the show. Yes, thank you. Thank you,
Izzy. But what is critical? So, therapy cat aside,
critical is when you have someone who's very,
very sick. This is someone who is, another term
that you may hear, acute. Someone who has an
acute condition, which means critical, which
means it's a very bad situation that might be
recoverable. Might not. Okay, I see. Well, then
what about terminal? So terminal is probably
the worst one that you want to hear when in a
conversation with a medical professional because
terminal means that the illness has progressed
to the point that there is no recovery and you
are now looking at a life -limiting situation.
This is usually when hospice is called in. Okay.
Well, why is it, I guess it's sort of obvious
why it's important that these be distinguished
from one another. A chronic situation, much lighter,
much something that you can live with, I guess.
Absolutely. Absolutely. Chronic illnesses, they
can be bad. I mean, lupus is considered to be
a chronic illness because it doesn't go away.
it's not life -ending you know it may be a nuisance
and it may be affecting quality of life but it
it's not going to end your life in the near future
i see so things like well where where do things
like you know parkinson's or that where where
does that sort of uh of an issue fall in the
chronic critical and terminal range so these
are things that actually progress so parkinson's
dementia alzheimer's these are chronic illnesses
that can reach a terminal stage so in the beginning
when they progress slowly you're looking at a
chronic illness it's not something that can be
cured it's not something that's going to go away
it's just going to progress over time As these
progress and they get worse and they get to the
point where they're now interfering with one's
ability to live. For example, with dementia,
when you have someone who's maybe no longer able
to swallow. Now you're looking at situations
that are becoming more critical. They're in the
critical range. Because they're creating scenarios
where life could be threatened. I see. And when
they become unmanageable, I suppose that's when
they reach the terminal stage? When someone is
terminal, they've reached a stage where their
life expectancy is usually not much beyond six
months to a year. Like I mentioned in a previous
episode. Someone who is admitted to hospice has
a life expectancy of six months or less, along
with a terminal diagnosis. I see. This means
that they have an illness that's going to take
their life within the next six months, most likely.
Like we also talked about during that podcast,
that's not guaranteed. None of us are born with
an expiration date. Nobody knows for sure, but
if the disease progresses as it normally would
that is the expected time frame. Right. But everyone
is different. Everyone is unique. And, of course,
consult your own health care professional that
has a much better idea of what your individual
needs might be, always. But we do welcome you
to join the conversation and leave your comments,
leave your thoughts and questions down below,
and we will see them. We will address them in
upcoming episodes. What is the important takeaway
whenever you hear the words chronic or critical
or terminal from your health care professional?
So the key takeaway there is to keep in mind
that these are determining factors in terms of
the plan of care. And by plan of care, I mean
the course of medical treatment is going to be
determined by whether the doctor feels you have
a chronic illness. a critical illness or a terminal
illness. Or a cath that's attached to you and
is becoming difficult to get to the ground. Okay,
so it determines your medical care and how the
doctor and you, how that conversation is going
to progress. What can you do in each of these
states to give you, you know, our focus is always
on the very best. quality of life possible. And
we don't focus on end of life. We don't focus
on those issues. We focus on how you live every
moment leading to those eventualities, which
we all face. So the key thing that you want to
do in all of those is you want to stop and assess
how you define a good quality of life. Okay,
how do you do that? Well, you look at the things
that are important to you and you think of the
things that you can't do without. And don't think
of the obvious things. Of course, we all need
oxygen. We all need to be able to breathe. But
would you consider yourself to have a good quality
of life if you couldn't get out of bed? Would
you consider yourself to have a good quality
of life if you weren't able to recognize anyone
around you? So if you did not have the ability
to be independent, if you could not take care
of yourself, if you could not have that mental
awareness, is that a quality of life that you
would want your life prolonged in? Because if
the answer is no, it's a good time to start thinking
about having that conversation with your family
about what kind of medical treatment you would
want if you reach a situation where you can no
longer make your own decisions. Ah, because that,
again, is one of those factors that may enter
in once things become critical. Absolutely. And
what some people don't realize, and this is something
that I've heard a lot, well, when I get to that
point, I'll decide what I'm going to do. No,
you won't. You won't be able to decide. Exactly.
Exactly. And a lot of people don't realize that
a situation can go from chronic to critical.
to terminal very quickly oh that's a good thing
to keep in mind and especially that i think most
everyone puts themselves in their mind into the
situation that they're in right now not really
able to imagine that situation any different
correct and it's really hard to put yourself
into the position into the frame of mind that
okay When I'm not able to think as I am able
to think right now, then I'm going to decide
to do something different. No, you won't. You
won't be able to. You won't know you need to.
And probably one of the biggest things that I
have heard that makes me cringe every time is,
my family will know what I want. Or my favorite
one, the doctors know what to do. Oh, ho, ho,
ho, ho. So if you leave your care in the hands
of doctors, they are required, they are required
by their Hippocratic Oath and by law to do everything
possible to keep you alive for as long as possible,
regardless of whether or not you are in a quality
of life that you find acceptable. And that's
where that quality of life becomes important.
And if you're not able to tell them what quality
of life you feel is acceptable, then they make
that decision for you, which is simply to maintain
you. That could be awful. That could mean living
on a ventilator for years. Years. And if you're
on a ventilator, guess what? Now you are hooked
up to a machine. 24 -7. You no longer have the
tube going in your mouth and down your throat.
Now you have a hole in your throat with a tube
connected to it that's still connected to the
machine that can't, most of the time, be maintained
at home. So now you're in a facility 24 -7. Now
if you're someone who wanted to live out your
remaining days at home, not hooked up to machines,
gone. potentially you didn't have any choice
in that matter. Correct. And one of the things
that we most strongly advocate for on this show
is being able to live life on your own terms.
And part of that is informed decision -making.
Okay, what is informed decision -making in the
little bit of time we have left? Informed decision
-making is basically where you have the information
that you need to make the decision. to get the
care that you want to receive and not get the
care that you don't. And that makes sense. So
informed decision -making is having the right
answers to the right questions. Correct. Knowing
the questions. And being able to make good decisions
for yourself when you're still able to, and being
able to express those so that your doctors, your
family, all of your caregivers... will know what
your wishes are once you're no longer able to
tell them. And it's not just about being able
to guide your own care. It's taking that burden
off of your family. I cannot tell you how many
times I've been standing in the ICU with a family
devastated over having to make the decision to
take a loved one off life support, and they're
wondering if they did the right thing because
they didn't know what their loved one wanted.
And you know what I can imagine? You say that
your loved ones will know what your wishes are.
and this one will know that your wishes are this
this one will know that your wishes are different
from that and this one will know that there's
an entirely different scenario that they think
is what you would want. Because everyone has
a slightly different perception of every member
of their family and what their wishes might be.
Correct. And you and I both have seen situations
where it's in writing, it's in black and white,
and you've still had siblings fight over the
plan of care because they interpreted it differently.
And that's one of the most heartbreaking parts
of the entire equation because that divides families.
That hurts feelings that sometimes are never
able to heal correct so if anything that we say
on this show is able to help any family prevent
that and and step away from all of that divisiveness
then we've done something good absolutely well
Of course, this is all a highly personal choice
and no conversation that we have on the Light
Keepers podcast should ever take the place of
your own medical care team or other professional
advisor who should always be consulted by you
on your specific situational needs. And it's
always good to be willing to talk about quality
of life because every single one of us faces
some of these issues some of the time. Either
not prepared at all or very well prepared indeed.
for joining us here every Wednesday at 7 p .m.
Eastern for the Light Keepers podcast. This is
an exclusive production of Vanimation Studios
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