Sharmon Figenshaw ARNP, ACHPN is HCPNW’s Serious Illness Clinical Consultant and is Co-Chair for the Washington POLST Task Force.
When I was dating my now-husband Peter, we took a ski trip to Oregon. Driving home, he asked “Do you mind if we stop and see my aunt? It will be quick, maybe 15-20 minutes—I just want to say ‘Hi’.”
Bobbi was Peter’s dad’s twin sister; she was 92 and residing in an assisted living home in southwest Washington.
“Sure!” I said, “ I would love to meet her!”
Well Bobbi and I hit it off and we were there for almost 2 hours. We talked about her life in southwest Washington, the adventures she and her deceased husband had, and what was bringing her joy in her current life. I was surprised to hear her say how happy she was in the home she had created for herself in the assisted living home, including the people she liked to see every day, many of them staff who she felt very close to.
She was remarkably up-front and willing, almost excited, to talk at length about her health, her wishes, what dress she wanted to be buried in, and who should be called to come see her in her final days. We talked about how her eldest son Bill was her “person.”
She said, “He is the one who will take care of things when something happens to me.”
I responded, “It sounds like you are very happy here and plan to stay here…”
“Yes,” she affirmed, “ I hope to die right in that bed.”
That led me to ask a question that I have found vital in my work with POLST (Portable Orders for Life Sustaining Treatment) and advance care planning: “Have you talked to your family and your doctor about all this? Does Bill know?”
Bobbi answered as most people do, “Well…I figure they all know, but we have never really talked about it like this.”
I shared that Bill and others might call 911 and that responders would likely try to save her life with CPR and other treatments. I also explained that she would probably end up in the hospital and likely die there.
“…Even if they know that’s not what I want?”
“Even then,” I informed her.
She assumed talking to the staff would be enough to prevent unwanted care.
We encouraged her to let Bill know she wanted to talk to him about her plans, including what she had told us, and help him understand what medical treatments would be right for her.
It turns out she didn’t have a POLST form—had never heard of it. Her doctor only saw her once a year. Nurse practitioners completed any periodic reviews or medication refills for residents. Although Bobbi thought her doctor knew how she felt, she couldn’t actually remember talking with him. It turned out the living facility staff listed her as Full Code (meaning all treatments) which didn’t align with Bobbi’s preferences.
Peter and I were able to start a conversation with Bill about Bobbi had told us. It was awkward at first, but we outlined what we had heard from her. He, like his mom, had not realized the importance of planning. We encouraged Bill to talk with his mom about her wishes, and to go with her to her doctor to discuss having a POLST for her. He also saw how important it was to work with the facility to make sure they knew that she wanted hospice involved when the time came for end-of-life care.
Seven months later we learned Bobbi had a stroke. Peter and his cousin had a way to talk about her needs because of the earlier conversations; they both advocated for immediate hospice.
I am so glad I said “YES” to that “15-minute” stop. I am glad I got to know Bobbi and, most importantly, I got to support her end of life wishes and preferences. It continues to be a very special memory for all of us.