Mapping Our Trail

“Journeying: Mapping Our Trail,” Rev. Jim Turner

READINGS:

From the Hebrew Scriptures:  Genesis 1:31-2:3

From the Christian Scriptures:  Mark 6:30-32

An adapted excerpt from a poem by Billy Collins

Aristotle

“This is the beginning. 
Almost anything can happen… 
 
This is the middle. 
Things have had time to get complicated, 
Messy, really.  Nothing is simple anymore… 

And this is the end… 
It is me hitting the period 
And you closing the book… 
What we have all been waiting for, 
What everything comes down to…” 

REFLECTION

“This is the beginning.

Almost anything can happen…”

In the Hebrew Scriptures God looked over his creation and he saw that it was “very good.”  Then, God rested from the work that she had done.  In the Christian scriptures, all three of the three Synoptic, or similar Gospels, Jesus takes his disciples away to a distant place.  This story is used as an introduction to the narrative of the feeding of the crowd.  However, in Mark, the earliest of the Gospels, the intent of getting off by themselves is stated: so they can“rest a while.”

The scriptures, start with the creator declaring of his creation,  “Indeed, it was very good.”(Gen. 1:31)  And then God takes care of himself.  God rests.  In the Psalms, the body is praised in song, singing how we are “knit… together” in our mother’s “womb;” and it is “fearfully and wonderfully made.” (Ps. 139:13)  The Apostle Paul, writing to the church at Corinth, describes the body as a “temple,(1stCor. 6:19)a house of spirit.  In Mark Jesus cares for hisspirit by getting up early to pray. (Mk. 1:35)  And in Luke Jesus goes to the synagogue to pray, “as his custom was.” (Lk. 4:16)

There is plenty of encouragement in the scriptures for us to have good stewardship of our physical, emotional, and spiritual selves.  Our culture isbecoming a health minded culture.  Medicare and many insurance companies now cover a yearly check-up by our primary physician. Exercise and good nutrition have become a major item for marketing.  And, there has been a shift from emphasis on quantity of life to a focus on quality of life. We talk about things like “healthy diet,” “optimal exercise,” “spiritual well-being,” and “Best practices in  health care.” Overall care of our being from birth to old age is better than it has ever been.  But…

“This is the middle.
Things have had time to get complicated,
messy, really. Nothing is simple anymore…”

In a television ad for Esurance, actor, Dennis Quade says, “no one wants to talk about insurance.” We especially don’t want to talk about life insurance.  We humans would like to keep thinking that with good diet, exercise, and healthcare we can live forever.  The reality is, we arecreated with “planned obsolescence.”  Like it or not, from the day we are born, we begin dying.  Like a well maintained machine, even our “fearfully and wonderfully made(Ps. 139:13)  bodies are aging.  With time parts will begin to wear out and fail us.  At some point, every single one of us will have enough parts wear out and we will die.

We have no control over whether we will die.  We can have a little control over howwe will die.  But we have a great deal of control over how we are cared for as we die.

Like insurance, we really don’t want to talk about these things.  But we need to!  Imagine for a moment an 18-year-old who goes out with her friends to a drinking party.  She drinks a little too much.  On the way home she misses a curve, the car roles over and she is thrown out the window. She ends up in the ER on a ventilator.  Who makes health care decision for this 18-year-old?  At 18 an individual is no longer a minor.  Mom and Dad are no longer their legal caregiver.

Picture a 22-year-old having a motorcycle accident.  He is on a ventilator and the physicians have done the best they can. Sadly, he has had a serious head injury. He has little to no brain function left.  Both his live-in girlfriend of two years and his parents tell the doctors, “He would not want to live like this.  Take him off the vent. Let him go.”  His ex-wife has leaned about the accident.  She still can’t let go him.  She arrives at the Intensive care and tells the doctors, “You can’t take him off the ventilatorYou can’t kill him.”  This young man had never legally divorced his ex.  According to Illinois state law, guess who his designated medical decision maker was.

Envision a 50-something couple on vacation.  They are in a highway accident and both are injured.   Early in their recovery, neither of them can make their own medical decisions.  Not a problem, in this state, their next designated decision maker would be an adult child.  They have three adult children… One of the children cannot agree with the other two on her parent’s care.  How do you think this family division affects the couple’s care?

Based upon 30 years in the hospital as a Board Certified Chaplain, every individual who turns 18 years of age should complete advance directives.  Perhaps here I should offer some definitions.

An Advanced DirectiveIs a group of legal documents which give healthcare directions in advance of the need.

  • A Durable Power of Attorney for Healthcare (POAHC) – is a document where you designate a legal healthcare decision maker for any time you are too sick or injured to speak for yourself.
  • A Physician Order for Life Sustaining Treatment (POLST) – is a doctor’s order for providing care according to your wishes when life support may be needed.
  • A Do Not Resuscitate (DNR) – is a doctor’s order to not do heroic measures of any kind if your heart stops or you stop breathing.

Power of Attorney for Health Care

By a show of hands, how many have a completed, signed, and witnessed Power of Attorney for healthcare?  “Oh, my wife will make decisions for me.”  “My children know what I want.”  And if your wife is down the same time you are?  What if your children cannot agree on the decisions to be made?  These are the reasons I often hear for why patient don’t feel a need to have a Power of Attorney for Healthcare.

This is the Power of Attorney for Health Care form we make available at all Advocate Arora Hospitals. The first few pages are information about the document and questions to ask yourself as you complete it.  The last, two-sided page is the actual state document.  Advocate Arora has added a location for the patient’s ID sticker to be placed.  It is a document designed for a lay person to fill out on their own or with minimal help.  I’ve placed copies of this document on the back table.  Feel free to take one to look over and/or fill out.

Physician Order for Life Sustaining Treatment

I have also placed copies of this document on the back table.  The POLST should be gone over with your primary physician since it is a physician order which needs to be signed by a physician.  This document replaces the old, weak Living Will and the more black-and-white DNR or Do Not Resuscitate order.  The DNR basically says, “I want no heroic measures of any kind done.  It is an all-or-nothing physician order.  (I’ll say more about the DNR and when it might be used next week.)  The POLST allows one to sit down with their physician and choose from all the different treatments used to revive a person.  You can decide which ones you want and which ones you don’t.  With a physician’s signature, it becomes a binding physician order.  It can be shown to an EMT or Paramedic or to an Emergency Room physician. They will follow it.

People often ask, “Now that I’ve completed these documents, what should I do with them?” Well, the original should be kept wherever you keep your important documents.  A copy should be kept where it can be acquired in the middle of a Sunday night!

(In other words, not in a bank vault!😊)

A copy should also be given to the agent or decision maker listed in your POAHC, as well as one for each of any back-up decision makers you list.  Of course, your physician should have a copy of each document in his or her office record.  Then, if you ever need to go to the hospital for any reason, take a copy and it will be put in your permanent record.  Finally, every few years you should review your POAHC and POLST to see if anything has changed requiring up-dates to be made.

When Jesus went to the synagogue “as his custom was,”(Lk 4:16) he read from the Hebrew scriptures.  Those ancient writings emphasized the wonder of life and the need to care for it.  Much of what Jesus taught was how to live life better.  Living a better, more meaningful life involves good choices.  I’m currently a Board Member of the McLean County Chapter of Compassion and Choices.  We are an active Board.  That is, we are actively involved in the work of educating individuals and groups about health care choices.  That is why I decided to speak on the subject this morning.  What choices do you have when it comes to life sustaining and life preserving measures?  How do you protect those choices?  The Power Of Attorney for Health Care and Physician Order for Life Sustaining Treatment are two documents that protect your choices.  If you would like one-on-one assistance completing a POAHC or POLST, let Susan know.  I’d be glad to meet with you one-on-0ne.  If enough of you would like individual help, I can schedule a time for a couple of us from Compassion and Choices to come to the CRC and sit down one-on-one with individuals to complete these documents.  If you are a member of the ARC – Adult Recreation Center, C&C Board Members are at the ARC two times a month helping individuals or couples with both the POAHC and POLST.  Phone the ARC and they can set you up with an appointment.

And this is the end…
It is me hitting the period
And you closing the book…
What we have all been waiting for,
What everything comes down to…

Next week I will discuss the choices we have available to us as we approach the period and the closed book.  Why is the Living Will no longer a meaningful choice? When might a DNR be an appropriate choice?  And what about the choice already available in ten other states.  The Illinois Legislature is likely to bring a similar law up for a vote in the next year or so – Medical Aid In Dying, (MAID)?  Like insurance, no one wants to talk about these things.  But if we do not talk about them; if we do not know the choices we have; if we do not make our choices known; if we do not give someone the legal authority to make our choices for us when we cannot; then we have no choice.  I don’t know about you, but I want to make sure my own choices are made and are respected.

And, for me, that is a BIG, AMEN!