By: Brian Hennon
The ambulance pulled up to the Emergency Department, the doors swung open, and the staff sprung into action. Sue was only 58-years-old, but had suffered a major medical event and was now unable to communicate. She was found unconscious, with no pulse in the locker room at her gym and there was no way to know how long she was there.
The staff at the gym called 911, began CPR and when the EMT’s arrived, they were able to get her heart restarted with a defibrillator. Sue still wasn’t breathing on her own and because of the chest compressions, she now had broken ribs and damage to her lungs.
In the midst of the chaos, a staff member in the E.D. found her identification and eventually tracked down her 19-year-old daughter. About 30 minutes later Sue’s husband, Dave, their daughter, Amy, and Sue’s sister, Liz came running across the parking lot and into the E.D.
They ran to the reception area, frantically trying to find out what was happening and were asked to have a seat. Someone would be out to see them shortly. About ten minutes went by, but it felt like hours and a nurse came out to meet the family. She asked if Dave was Sue’s husband and he nodded, so she said she would be taking him back to her room.
Liz protested, claiming a few weeks before, Sue had confided in her that she wanted a divorce. She insisted that she should be the one with Sue.
Dave felt blind-sided and an argument began in the waiting room.
The nurse called her supervisor and since Dave was Sue’s next-of-kin, they asked him to come with them to Sue’s room. Liz was furious and demanded to go as well, but Dave refused to allow her. Eventually hospital security had to intervene and informed Liz that if she wasn’t going to cooperate, she would have to leave the hospital.
Dave nervously followed the nurse to Sue’s room and as they pulled the curtain back he was shocked to see her lying there with wires and tubes all over her body. A large mask covered her face and there were beeps, alarms and the periodic whooshing sound as oxygen was pushed into Sue’s lungs.
A short while later a doctor came in and explained what had happened. Sue had suffered stroke and her heart had stopped beating. They were able to get her heart started, but no one knows how long her brain was deprived of oxygen and it was too early to tell if she would ever breath on her own.
After a few hours, Sue was moved to the ICU. Dave was asked to wait in the waiting area and they would come and get him when Sue was settled in her new room. In the waiting room, Liz was getting angrier by the second. Why weren’t they telling her anything? How could they trust Dave, especially after what Sue had told her?
Dave walked out and their daughter Amy ran to him and hugged him. He gently held her hand and walked to a corner in the room with Liz following, peppering him with questions.
While Dave was sharing everything he had been told by the doctor, a social worker walked up and began asking the family questions.
Does Sue have an Advanced Directive or a Living Will? She didn’t.
Has Sue ever expressed her wishes to anyone? She hadn’t.
Then she asked, “who will be making decisions for Sue?”
Liz immediately said, “I'm her sister…I will make decisions for her.”
Dave shouted, “No I’m her husband, that's my responsibility!”
The social worker made the same decision the nurse had made previously. Dave was Sue’s spouse and legally her next-of-kin, so she asked him and Amy to walk with her to another family waiting room. She asked if he wanted Liz to come as well and he said, no. This infuriated Liz even more and she threatened to call a lawyer, but Dave didn’t relent.
On the second day in the ICU, Sue still wasn’t waking up and her heart stopped again. The ICU team was able to get it started again, but now decisions needed to be made. There was significant damage to Sue’s chest, lungs, and there was no indication that she would be able to recover from this.
The social worker and physician came into the room and asked Dave what he wanted to do.
If Sue’s heart stopped, would he want them to perform CPR again? Dave didn’t know how you answer that.
They asked, “What would Sue want?”
Dave didn’t know that either.
Over the years they had discussions about dying, but nothing serious. The conversations were always uncomfortable and Sue usually dismissed the topic by saying, “just put me in a box and bury me in the yard.”
Eventually after meeting with the attending physician, palliative physician, and social worker, Dave decided to sign a Do Not Resuscitate order for Sue. It wasn’t something he had ever thought he would have to do and the decision was agonizing.
When Liz heard that he had made Sue a DNR, she became furious and accused Dave of murdering her sister. She then called the hospital and demanded to speak to someone about Sue’s case. Due to privacy laws, the hospital wasn’t authorized to give her any information, so Liz contacted a lawyer.
The lawyer petitioned the courts for injunctive relief, challenging Dave’s decision on the basis of Liz’s testimony claiming Sue’s desire to file for divorce. The courts issued a order that the DNR was not valid until the case could be resolved.
Over a month went by and Sue’s condition didn’t improve. Her heart stopped, but the hospital was legally bound to perform CPR to try and keep her alive. They weren’t successful, but the damage had been done, not only to Sue’s body, but to her family.
Though this story is fictional, it’s something that happens time and time again in America. There have been very famous cases, but countless more play out in hospitals and long-term-care facilities all over the country.
A study revealed that only 1 in 3 people in the United States have an Advanced Directive of some sort.1 67% of Americans haven’t made a plan for the end of their lives. Most of those people have the same mindset Sue had – “just put me in a box and bury me in the yard.”
Let’s face it, when the time comes, most of us want a sudden, peaceful death. But the reality is, those are in the minority.
Nationwide, only 15% of Americans die from what is called out of hospital sudden unexpected death.2 That means 85% of the people who die each year in America, experience a slower, prolonged death, usually resulting from a chronic, long-term illness.
For many of those people, as they decline slowly, someone else has to make decisions on their behalf and if statistics are true, 67% of them will have no idea what decisions to make. Those loved ones will have to live with the choices they make and wonder every day if it was the right one.
One of the greatest gifts we can give our family and friends is loving them enough to tell them what we want. For those who follow Jesus, it's also a perfect way to honor and worship him.
In a very familiar passage of Scripture, Jesus was confronted by a legal expert of his day, asking, “teacher, which is the greatest commandment in the law?’
Now, there are over 600 laws in the Old Testament alone, so you might think Jesus would have to take his time with this question. You would be wrong.
Jesus replied: “‘Love the Lord your God with all your heart and with all your soul and with all your mind.’ This is the first and greatest commandment. And the second is like it: ‘Love your neighbor as yourself.’ All the Law and the Prophets hang on these two commandments.”3
All the law and all the prophets are summed up in these two commands. Let me say that again…ALL the law and ALL the prophets.
That’s an amazing statement. Every law written in Scripture – over 600 – and every word the prophets spoke hang on these two commands. What does that mean? Think about when you were little and would climb a tree. You would sometimes hang from a branch and that branch supported you and your life. That’s what this means.
Every law…every command…every prophetic utterance is supported and fulfilled by obeying these two commands.
The first command is clear – love the Lord your God with everything – your heart, mind, and soul. The second command, Jesus says is “like it”.
What in the world does that mean?
Does that mean we are Gods? No, it means one of the primary way we obey the first command is to do the second. In another passage of Scripture we read that claiming to love God, but hating our brother or sister makes us a liar.4
The primary, number one, most important display of our love for God isn’t our church attendance, prayers, how loud we sing, or how high we raise our hands – it’s loving our neighbor like we love ourselves.
What does this have to do with Advanced Directives and Sue's story? Everything.
Stories like Sue’s impact dozens of people. Dave, Liz, Amy, the doctors, nurses, social workers, EMTs, lawyer, judge – all making decisions for her without really knowing whether they were making the decisions she would want.
These decisions are weighty enough on their own and to place them on the shoulders of someone else, without clear direction, is a burden no one should have to bear. This is especially true when it can be avoided simply by having an honest, open discussion.
I get it, no one really wants to talk about dying.
We have this strange notion that not talking about something will make it go away, but we can’t ignore death away.
It’s coming whether we talk about it or not and according to statistics, it’s coming slower than expected for 85% of us.
So, talk about death and by doing so, love your family, friends, and healthcare workers. Use it as an opportunity to reminisce, cry and yes, even laugh! Make sure those closest to you know what you want so, when the time comes, there is no guessing and no guilt.
Give the gift of certainty to those you love.
For pastors and church leaders reading this, you have spent countless hours teaching your congregations how to love God throughout different stages of life. You have taught them how to live well - how to be married well, raise children well, give well, worship well, and serve well.
Isn't it important to also teach them how to die well? Shepherd your people by helping them have these conversations. If you aren’t sure where to start, head over to the contact page and send me a message.
For everyone else, send me a message if I can help getting the conversation started with your family. Let’s talk. I promise we will find joy as we have these conversations.
References
1Yadav, Kuldeep, et al. “Approximately One In Three US Adults Completes Any Type Of Advance Directive For End-Of-Life Care”, Health Affairs Vol. 36, No. 7, (2017).
2Lafaro, Alyssa. “Without Warning: Why Do People Drop Dead?” UNC Research (2017).
3Matthew 22:34-40 (NIV)
41 John 4:20