[Darris McNeely] Welcome to Beyond Today Interviews. This is part two of a discussion with Andi Chapman, a registered nurse who has for 18 years been working specifically in the field of hospice care, working with those who are facing end of life issues and how to deal with all of that, not only from the patient side but from the family. Andi, we're glad that you are here with us.

[Andi Chapman] Thank you.

[Darris] So, your experience I think is going to help a large number of people. Dealing with these issues, dealing with all of the things that have to be done when it comes to concluding a life, it's something we want to put off. You had talked about this thing called "someday I'll." Explain what that is.

[Andi] Oh, someday I'll. I actually got that, that thought, because we had a file in our file drawer and we put things in there that we were going to do. Someday I'll do this and someday I'll do that. And I threw the file away because we never did it. But when we're dealing with life and particularly when we're thinking about what may happen toward the end of our lives, you don't want to go to "someday I'll" anymore. You need to prepare because this is something that is going to happen to every single one of us. And so, to prepare our families for what would happen if I weren't there, whether you're a young married couple or an older couple with children or even just an older person, single, you still need to prepare for your family for those left behind, the ones left standing and "someday I'll" doesn't apply. You have to prepare for someday now

[Darris] Why is it you think people put this off and don't want to discuss it?

[Andi] Do you want to discuss dying?

[Darris] No.

[Andi] Okay.

[Darris] I want to discuss living or next vacation or trip or next book I want to read or outing with my family.

[Andi] Right. There's a finality that goes along with the word death and we don't like to think about that. And even if you believed in reincarnation or even if your belief is that you're going to be resurrected, you still don't want to end this life. We're here and we just don't want to give that up.

[Darris] So, I guess a person who even believed in reincarnation, which I don't, they still got to exit this life and there's things that have to be tied up and settled, right?

[Andi] Absolutely.

[Darris] That's the reality of life in this light today.

[Andi] Yes.

[Darris] We don't want to deal with that, do we?

[Andi] And that belief actually impacts us because I wasn't allowed to kill bugs at my office because it could be somebody who really messed up in their life and they came back as lower life form. So, I couldn't kill bugs in my office.

[Darris] Well, you must have an interesting workplace.

[Andi] It was.

[Darris] A few more interesting rules and regulations and guidelines and some others other have. All right. Let's get down to some specifics as to what it is, some of it we've talked about in the previous program, we talked about hospice care, palliative care, and dealing with a lot of that. Let's look at some of the practical aspects of the legalities that have to be put in place to deal with our life and the decisions that will be made even while we are still alive, much less after we are alive. There are certain documents, I think everybody knows about the will, the last will and testament, but a bit more complicated than that today, isn't it?

[Andi] It is very much so. There are two specific cases that come to my mind when I think about the papers that we really should have prepared. Because we, again, we, you know, prepare for all these things but we aren't preparing for the end of life. And one of the cases was the Terri Shiavo case, you know, she had hypoxic situation in the brain, which basically means no oxygen.

[Darris] This was in the state of Florida?

[Andi] Yes.

[Darris] Several years ago.

[Andi] Yes. And she was 24 years old when she had this event and didn't have any paperwork. And as her condition deteriorated over the years, her husband petitioned the court and he said, "She told me she doesn't want to live this way." Well, there was nothing written down and it was a big embattled situation. Even Jeb Bush got involved because of Terri's law. They were trying to find a way to keep her alive, but ultimately, her husband did prevail and they were able to take away the feeding tubes and she died. It took 13 days, but she died. Her parents did not have the right to have that feeding tube reinserted inserted because he was her guardian. So, you know, that legality was a huge issue and I think it impacted our nation. The other thing that occurred is a friend of mine, her father had a very, very bad stroke and he was essentially without brain function. But he was put in a teaching hospital. He had no power of attorney, he had no advanced directives, nothing was written. And it took almost three weeks to get permission from the courts to have his life support terminated. And so, it is a very emotional situation when we don't have those discussions and the papers in place, it's a huge, huge emotional situation and it impacts our families forever.

[Darris] The lessons that we learned from that are get the paperwork done.

[Andi] Right. If something were to happen that you and your wife didn't have paperwork. And...

[Darris] Let's talk about what specific types, IEB. Say I'm 45 years old, kid still in high school, middle school, mortgage, suburban, two cars, three kids. What do I need?

[Andi] You probably need advanced directives. Definitely.

[Darris] Advanced directives.Tell me what that is.

[Andi] Okay. Advanced directives are papers that everybody has access to in every single state. You can go to the government website, you can pull them up and you can fill those papers out in the privacy of your own home. It would include what you want done if you were in a vegetative state or, you know, you can go through all of the various scenarios that might occur to you in a medical manner and how you want things taken care of. It can even go so far as to how you want your body taken care of after you've expired. But it also includes something in there called the power of attorney. The power of attorney can be two different individuals, one for financial and one for healthcare because not everybody's good at both. So, you might want two different people in there.

[Darris] And I guess it's important to emphasize that there are two different types of powers of attorney. You're saying that even a middle-aged person, still working, 30 years ahead, you know, thoughts of retirement, whatever, they need a financial power of attorney and a health power of attorney.

[Andi] Right. Because your healthcare power of attorney, this is the person who's going to determine whether or not they follow all of your wishes as far as life support, feeding tubes, that kind of thing, treatments and care. The other person is going to be that financial guru. How are we going to pay for all of this stuff and what's going to happen in the future with this?

[Darris] Can you combine both into one?

[Andi] You can.

[Darris] One person?

[Andi] You can. Yes.

[Darris] Is it advisable you think?

[Andi] It depends on the person.

[Darris] I'm not asking you as a lawyer but from your practical experience.

[Andi] I know from the people that I am familiar with that it's rare to find somebody who can do both. Because if you're dealing with the emotional portion, the healthcare portion, it's a very emotional side. And sometimes we can make poor decisions financially as a result of that, but not everybody is in that boat. So, you know, it really depends on the person. It would be you talking to them, you'd have to know them very well to even ask them to do this for you because it doesn't always have to be a family member. It can be a very close friend.

[Darris] And in some cases people don't have a family.

[Andi] Exactly.

[Darris] And they do need a close friend.

[Andi] And they have to agree to it. So, in this document, the advanced directives, that signature has to be notarized. So, it has to be witnessed and it's a big position.

[Darris] Right. So, I've got someone lined up for this that's going to manage my finances, manage my healthcare. How does this relate to my will? You know, last will and testament, the traditional thing that disposes of property. How does it relate?

[Andi] Okay. The will is simply, it's a very basic thing.

[Darris] It's a separate instrument.

[Andi] It is a separate instrument. However, this is going to sound crazy 'cause you can actually have that put in your advanced directives. But a simple will is basically what I want to have done and who I want to have all my stuff. So, that's basically what a will does. It gives things to people. That can actually be included in your advanced directives, your advanced directives you can put on there. You know, I want so-and-so to have the hutch without all the knick-knacks on it, the knick-knacks go to somebody else. So, you can be real specific in it, but it's not so much...the will is not so much for health care directives as it is for what I want dispersing.

[Darris] Let's go onto what we, you know, the DNR, DNIs and these things that often end in kind of a living will that people have.

[Andi] The DNR is "do not resuscitate." The DNI is "do not intubate," which means that they're not going to put the air tubes and that sort of thing. The DNR basically says that if I'm found and I'm unconscious and my heart's not beating, I don't want CPR. Those are really great documents because when a person has to make that decision for their loved one, it's a very difficult decision. It's very emotional one. I've had a young lady who needed to sign a DNR for her mother and she was really reluctant to do so and I believe in informed consent. So, I did tell her that, okay, she can be a full code. That's not a problem, but this is what happens with a full code because it's informed consent. And she went ahead and signed the do not resuscitate order. But even though she signed it, it was very emotional for her. She didn't want to cause her mother harm, but in her mind by her having to sign that she was killing her mother. And that's the words that she used. So, when we have these illnesses, I really think that it's important to find out, "Mom, do you want to have CPR? Do you want, you know, somebody to go in there and press on your chest and do all of these things?" It's a great conversation to have, even for younger people. Now, depending on the age, things are going to change, but if we don't talk about them, how do we know?

[Darris] Andi, I want to go back to a comment you made about full code. Can you explain that in the context of these DNR, DNI?

[Andi] Yes. A full code would mean that we would do everything possible to sustain life. That would be including CPR, which would mean that we would do compressions on the chest. We would break bones, but we would massage that heart and try to get it going. We would also put tubes down the throat to provide air so that you don't have brain injury from lack of oxygen. That's full code. Do everything possible to sustain life.

[Darris] So, the DNR, DNI, basically short circuits that?

[Andi] Yes. You know, how many people have you heard say, "I don't want to live on a machine, don't put me on a machine." Well, essentially that's where you're going to go if we're doing full code. And some people come off of it and they do fine and others do not. But it depends on the level of injury, the level of disease process. All of these things are very important.

[Darris] These are tough decisions...

[Andi] They're very tough decisions.

[Darris] ...for family to come to an agreement on, I would imagine there are some families that there's division on this.

[Andi] Oh, tremendous amount of division and that's another reason why it's important that we have these conversations and we have the paperwork done.

[Darris] This is really talking about love.

[Andi] It is. Absolutely.

[Darris] Showing love for your family or those close to you as they deal with the impending loss of you, their loved one.

[Andi] In John 19, Christ even prepared for his own mother. He's on the cross, He's hanging there, He's dying and He looks at his mother and he says, "Mother, behold your son," and essentially transfers His mother's care to His most beloved. And I just think that's just such an amazing thing that even at that time He would consider that. And I'm sure He considered it. And in fact, it was probably not so much that He considered it, it was the norm in that culture.

[Darris] To think you're correct, yeah.

[Andi] But the norm in our culture, it's not that. And that's unfortunate because we have children that are going to be left standing as well. And even adult children, they're still children.

[Darris] What advice would you give to a young couple with, you know, children, elementary children, when and how is a good time to begin to broach the subject of death and explain things to their children?

[Andi] Well, truthfully we can start very young and help them to understand that life does end. You can do that with a goldfish, with a puppy, with whomever. But as the child ages, their concepts are going to be more concrete. They're going to understand a little bit better. So, a very small child might just say, well, you know, they'll be back someday. One of the things I think is very important that we don't say to children is that, "Well, grandma fell asleep and she's gone to heaven." Or grandma fell asleep, just leaving it at that. Or grandma has died. Because some children are going to have a real problem taking a nap after that, because they want to wake up at some point. So, I think it's really important the words that we use with the children as well. But as they age and they're able to understand a little bit better, I think it opens the door actually for spiritual lessons. So, don't be surprised if you're talking to somebody, a child, and they start asking you, "Well, why would God do this?" You would have to have some answers for that.

[Darris] So, with all that we've discussed, Andi, with the legal prep preparations, DNRs, DNIs and everything that it's good advice for people to do. What's the worst-case scenario if people don't do that?

[Andi] If people don't do that, first of all, you're making other people make decisions for you and they may not be what you wanted at all. Perhaps, and this sounds very cruel and very cold and I don't mean to, but let's say that you were injured to the point where you were most likely to die of those injuries. And now somebody has to make that decision that they're going to do everything possible. And now here you are in a vegetative state and your assets are being depleted to take care of you. Now, what happens when those assets are no longer there? You know, your family isn't being taken care of, you are being taken care of, but probably not to the degree that is going to be good.

[Darris] By people you don't know.

[Andi] Exactly. So, I would think that that would be the worst-case scenario. The best-case scenario. Okay, I have this disease process and I'm going to plan for my family as though I'm not going to be here and then, voila, your disease manages to go into a point of remission or something. So, you're able to carry on with life, but you know at least that you've done your best to try to take care of your family and they haven't had to make those hard decisions. You've done them together. So, I think that's the worst-case scenario. Worst-case scenario really goes back to Terri Shiavo and what happened with that whole thing and how that impacted our entire nation. Best-case scenario, everything's taken care of. Even if you are gone, everything's taken care of and you haven't had to make those hard decisions alone.

[Darris] So, as we were beginning to wrap this up and think about it, you have brought a lot of information I think that can be very helpful to people to approach this, this aspect of life, to help them to prepare. If you were to sum up your years of experience as a nurse and working in hospice care with people and could you kind of summarize the best advice you can give to people to help them in their life and their families to prepare for this phase?

[Andi] I would say to not be afraid to talk about death and dying, to prepare for death even though you want to continue to live. We have to be prepared for the unexpected things. It happens to everybody, but it's very loving thing to do. And it's difficult to get into those conversations, but I would encourage people to at least have them. Have the paperwork that's there because when things are happening and it's an emotional situation, you're not going to think clearly. What did she want me to do? I don't remember. Well, if it's written down, it's there. And it also helps to relieve the guilt for those who have to tell the doctor, no, we're not going to do that.

[Darris] I can validate what you've said, from my pastoral experience and from my own life experience, in recent years, both in my wife's family, my family that what you say and what you speak are words of wisdom. And I think that you're coming onto our program to share this should be very, very helpful for a lot of people. We appreciate the fact that you have come to do this. Thank you for watching Beyond Today Interviews, this topic on death and dying, presented by Andi Chapman here, a registered nurse. We appreciate your being with us. And be sure to watch future episodes of Beyond Today.