Welcome to the Light Keepers podcast, this week
from the Windy City. 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. Join us for the conversation this
week about could or should, and how they affect
your medical care, and so much more on this very
special edition. of the Light Keepers podcast
from Chicago, Illinois on the shores of Lake
Michigan. My co -host is always Charlene, our
very own licensed clinical social worker, licensed
in the state of Florida. Please leave your questions
or comments below and join our conversation.
Questions are answered during our next show that
airs each Wednesday at 7 p .m. Eastern. The Light
Keepers Podcast is an exclusive production of
A Guiding Light Incorporated. So our topic today
is could or should. What does that mean? So we've
talked a lot on this show about how important
it is to have advanced directives and have your
wishes for medical treatment known. And the reason
for that is because in the medical world, especially
in hospitals, doctors will do everything they
can to keep you alive. And their thought is not
on what kind of quality of life you're going
to have. But whether or not you're alive, that's
all they care about. Are you alive or are you
not? They're not thinking about, is it a quality
of life that you're going to be okay with? Is
it a quality of life that you find acceptable?
And quality of life should be a determining factor
when it comes to your health care. You just roll
back just a second and ask, what is the definition
of quality of life? What does that really mean?
Well, I guess it means something different to
almost everyone. Quality of life is subjective
because each of us has something different, a
different idea of what a good quality of life
looks like. For some people who maybe they're
fiercely independent, they... can't stand the
thought of a quality of life where they're not
ambulatory. Being confined to a wheelchair is
not something they would ever be okay with. For
some people, being confined to a wheelchair isn't
a problem for them, provided they still have
their mental capacity. I understand. For other
people, they don't care what mental capacity
they have. Being alive is the most important
thing to them. Each of us has a different idea
and a different definition of what a good quality
of life is, and that's why it's important to
include that in your advanced directives. Well,
you know, I mention often in our conversations
outside of the show a film by Richard Dreyfuss
called Whose Life Is It Anyway? Wonderful movie.
I highly recommend it to all of our viewers and
listeners. And it was all about a man who was
extremely intelligent, very live, very vibrant,
had a very dynamic life. And he was in an accident
where he became a paraplegic. Below the neck,
nothing. And his decision was he wanted to end
his life in the hospital. And, of course, they
wouldn't let him. Their goal was to keep him
alive at all costs. and hence the title of the
movie whose life is it anyway it was a very controversial
very interesting topic very delicately and brilliantly
handled if i might say in the script and i recommend
that as viewing for anyone who has ever had the
thought or the concern about the controversy
about whose life is it anyway who determines
when my quality of life is not acceptable to
me Well, and I think that so often in the medical
world, talking about movies, let's talk about
Jurassic Park, Jeff Goldblum. We spend so much
time thinking about whether or not we can. We
don't stop to think whether or not we should.
Absolutely. Jeff Goldblum playing the role of
Dr. Ian Malcolm in the original Jurassic Park.
And in that movie, he said, you know, the scientists
spend so much time worrying about what they can
do. they never stop to think about if they should
do it and what the repercussions are going to
be. What's the ripple effect to the actions we
take today? Exactly, exactly. And we have the
same problem happening in our hospitals and in
our ICUs and in our trauma units. I talk to people,
I hear from someone at least once a week. that
had a very bad experience in the hospital because
they had a loved one who had advanced directives,
but the hospital didn't have them on file. And
so by the time the loved one got to the hospital,
mom was already on that ventilator, and she never
wanted to be. And never had the choice to tell
or chance to tell. And now the very situation
that mom was trying to avoid by having those
documents drafted is now playing out because
the family is having to make the decision. to
take her off that ventilator. And the doctors,
if they don't know, are going to do what they
are chartered to do, which is keep you alive.
Regardless, basically, they're not concerned
with the quality of life, the condition of life.
They just want life. Exactly. Because that's
what they're trained to do. What you do with
the life that they give you is up to you. Exactly.
Paramedics are in the same boat. If they get
called out on a call where someone's heart has
stopped beating, unless that do not resuscitate
order is like glaring them in the face when they
come into the house, they're going to immediately
start CPR. That's almost an even more... difficult
to gauge situation because they're in an emergency.
They're in a time critical situation. They absolutely
have to do something. Right. Right. And that's
why when I'm talking to people about what they
would want and they say, when I talk about CPR
and they say, well, I'll let my loved ones figure
that out in the moment. I was like, there is
no moment. There is no moment. It either happens
or it doesn't. And if that document... There's
no time to debate it. There's no time to worry
about it. No, they're not going to ask. They're
not going to ask. If the document is not already
done, they're going to do. And that's all there
is. Well, how does that play in with the paramedics
now? They're not going to see those documents.
Ah, not true. Not true. So one of the things
that I always tell everyone is if you do have
that do not resuscitate order, have it posted
somewhere where it is visible the minute you
walk in the door. Okay. You know, if the kitchen
is visible, a lot of people put it on the fridge.
If you have someone that spends a lot of time
in their bedroom, it's posted on the bedroom
door on the foot of the bed. Gotcha. And those
paramedics, because a lot of do not resuscitate
forms are a special color. Like I know in the
state of Florida, it's on a yellow sheet of paper.
Paramedics look for any sheet of paper of that
color. And if they see a red piece of paper or
yellow piece of paper, they're going to stop
and say, is that a do not resuscitate order?
Okay. And so you do have that opportunity to
make that known. Now, I have to ask, what if
they're in the car, they have an accident? They're
on the road. You're going to get CPR regardless.
So all bets are off when you're away from wherever
those documents might be. Correct. Unless you
just... Put it on the window of the car. Put
it on the dashboard. Tape it up. I don't know
what you can do. No, it's going to happen. It's
going to happen. If you do not have a heartbeat
when they find you, you are going to get CPR
done. Gotcha. So it's conditional, circumstantial.
And again, it's a highly personal choice, we
know. Is there anything else that you can add
to that? Thoughts about the could or should?
It is definitely something to give a lot of thought
to, and not just to think about whether or not
you want it, but is it something that you're
going to be okay with in terms of life support,
CPR, because there is that ripple effect, and
I'm going to explain to you very briefly exactly
what that ripple effect is. Okay. Okay, so say,
for example, you do want CPR done, okay? Right.
something happens, heart stops beating, they
do CPR, they're able to bring you back, but you're
not strong enough yet to breathe on your own.
So now you're on a ventilator. Okay. Okay? After
two or three days, you're still recovering. You
still can't breathe on your own. However, because
you're on a ventilator, now you can't swallow,
you can't speak, you can't eat, so now you have
a feeding tube. Talk about a ripple effect. So
here in the process of one intervention, you
have been subjected to three life support interventions.
So those life support measures, and what if you
were okay with two of those, but you didn't want
that third, but it's necessary now that the first
two have been put into effect. What do you do?
So now your family is put in the position of
either putting the stop on it. Say, for example,
someone was okay with the ventilator, but they
didn't want the feeding tube. which to me is
kind of interesting because the feeding tube
is the less invasive of the two, but that's for
another show. But they were okay with the ventilator.
They didn't want the feeding tube. So now the
family is having to say, well, they didn't want
that. So we either have to let mom go without
nutrition and hope she recovers the ability to
breathe before she starves to death, which most
of the time someone on a ventilator is going
to be sedated. They're not going to know that
they're not eating. or they've got to turn that
vent off and hope that mom can breathe on their
own. Well, you know, we're in Chicago. I can't
imagine getting one of those deep dish pizzas
through a feeding tube. So I would be resistant
to that, too. Actually, you can. Oh, my gosh.
So people live with feeding tubes every day.
Okay. The feeding tube that... feeding tube that
is used long term is put into place by making
an incision in your side and they put a tube
going through that cut directly into the stomach
now the tube is a little bigger than other tubes
and so you can blend food you can blend food
so you could puree something and put it in. You
wouldn't get the same pleasure. Believe me, I
had one yesterday and it's delicious. And that's
the whole thing. That's where feeding tubes,
a lot of people don't realize how much of our
society is focused around food. And if you're
not taking food in like everybody else, guess
what? You're not participating in Thanksgiving
dinner. You're not participating in Sunday family
dinners. It removes the whole social component
of eating out of it. Exactly. It does. Oh my
goodness. Now that's something I'd never thought
of. until this very moment. Yeah. Well, and those
are important things to think about and share
with your family and discuss with them as you're
talking about how you like things, don't like
things. And it doesn't have to be an end times
conversation. It doesn't have to be a last...
It should be an ongoing conversation. It's ongoing
because you know something, over your lifetime...
Your desires, your wishes, your thoughts about
this or that are going to change. They're going
to modify. You may see the movie Whose Life Is
It Anyway and change your entire perspective
about that subject, which is a very serious subject.
It's a sad movie. And a touchy topic. It's a
touchy topic. It's a sad movie, but it gives
you a lot of... Perspective. Perspective and
hope and things to think about, which we hope
also is what this show does for you, is give
you a lot of things to think about. So thank
you so much for bringing that to us and talking
about it here in the beautiful city of Chicago.
This conversation is to start you thinking because
most people aren't prepared, and that is the
truth. Most people are not prepared to even think
about this, much less talk about it. But some
are well prepared indeed. From joining us here.
at the Light Keepers Podcast each Wednesday,
7 p .m. Eastern. Ah, that's right. The Light
Keepers Podcast is an exclusive production of
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the Windy City. I'm Clayton Vandiver, your Lightkeeper.
We'll see you next time on the Lightkeeper's
Podcast. Thanks for watching!