- Doyouwanttubeorintravenousfeedingifyou
can’t eat on your own?
By1996, 85 percentofLaCrosseresidentswhodiedhad
awrittenadvanceddirectivelikethis,upfrom 15 percent,
anddoctorsvirtuallyalwaysknewoftheinstructionsand
followedthem.Havingthissystemin place,Thompson
said,hasmadehisjobvastlyeasier.Butit’snotbecause
thespecificsarespelled outfor himeverytime a sick
patient arrives in his unit.
“These things are not laid out in stone,” he toldme.
Whatevertheyes/noanswerspeoplemayputonapiece
ofpaper,onewillfindnuancesandcomplexitiesinwhat
theymean.“Butinsteadofhavingthediscussionwhen
theygettotheICU,wefind manytimesithasalready
taken place.”
Answers tothe listofquestions change aspatients go
fromenteringthehospitalforthedeliveryofachildto
enteringforcomplicationsofAlzheimer’sdisease.Butin
LaCrosse,thesystem means thatpeopleare farmore
likelytohavetalkedaboutwhattheywantandwhatthey
don’twantbeforetheyandtheirrelativesfindthemselves
inthethroesofcrisisandfear.Whenwishesaren’tclear,
Thompsonsaid,“familieshavealsobecomemuchmore
receptivetohavingthediscussion.”Thediscussion,not
thelist,waswhatmatteredmost.Discussionhadbrought
LaCrosse’send-of-life costsdownto halfthenational
average. It was that simple—and that complicated.
ONEWINTERSATURDAYmorning,ImetwithawomanI
had operated on the night before. She had been
undergoinga procedure for theremoval of an ovarian