Gurpreet K. Padam, MD

Planning Ahead &

A Graceful Exit

Why Talk About This?• We like to plan

• Short term – dinner with friends, samagams, keertans, • Long term - retirement, college, mortgage, family

planning Plan A and Plan B

• We don’t like to take about it• It’s not the most pleasant of topics• Fear of the unknown• Suffering and lingering The possibility of a good death?

Benjamin Franklin

“…in this world nothing can be said to be certain, except death and taxes.”

http://www.notable-quotes.com/f/franklin_benjamin.html

Guru Granth Sahib• 1430 Angs/Pages• 26852 lines• 29445 words

• “Hari” appears 9388 times• Reference to death (jam, kaal, mareh etc.) appears at

least 1,000 times

> 1000 times

Ref: Sikher and Sikhi to the max website search

Objective

Identify tools you need to plan ahead for:

1. The unforeseen circumstances2. Plan for the stages at the end of life

- AD- surrogate decision maker- POLST- Palliative care- Hospice

Show of hands - familiarity

Imagine a good death

- You do not have to participate- Close your eyes- Imagine your last days- Choose your surrounding- Choose who surrounds you- What are your wearing- Imagine the music/shabad in the background

How many people imagined the last days in the hospital?How many people imagined last days at home or surrounded by loved ones?

· Nearly half of all Americans die in a hospital.· Nearly 70 percent of Americans die in a hospital, nursing home or long-term-care facility.· 7 out of 10 Americans say they would prefer to die at home.· Only 25 percent of Americans actually die at home.· More than 80 percent of patients with chronic diseases say they want to avoid hospitalization and intensive care when they are dying.

How We Die

Ref: http://www.pbs.org/wgbh/pages/frontline/facing-death/facts-and-figures/

imRg iqRsnw ijau jg rcnw Xh dyKhu irdY ibcwir ]mrig thrisanaa jio jag rachanaa yeh dhaekhahu ridhai bichaar ||The created world is like an illusion, a mirage - see this, and reflect upon it in your mind.

Guru Tegh Bahaadur Ji Raag Dayv Gandhaaree 536

The Illusion of Control

Ref

When the unforseen happens, there seems to be sense of loss of control

• Natural disaster• Accident• Rapid progression of a disease despite maximum medical

treatment• What is the right treatment for you, who will make your

decisions, what is important to you?• CPR or DNR, Aggressive tx something else, tube feeding

What can we control?

Advance DirectiveYour wishes in writing

Who is your spokes person?

1

2 POLST – physician’s order for life sustaining treatment.Your doctor has to sign it too.

A copy of the original is also valid

http://capolst.org

3 Share Your AD + POLST- Your Doctor- Your Family

Out of sight, out of mind. Keep documents visible to the paramedics, your doctor, your family

Document Your Goals and Directives

Review every couple of years and update

1Advance Directive 2POLST 3Share

Advance Care Planning is in placeIllness progresses• Maximum treatment has been tried• i.e. asthma, copd, heart failure, complications of

diabetes, cancer, kidney disease, dementia, liver diease, dementia

• ”How much time do I have”• ”6 months”

Goal: Comfort at the end of life--focus on managing symptoms and treating suffering rather than seeking a cure--Medicare benefit for those with a terminal illness and 6 month prognosis.

Hospice

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What’s Your Message?Know Your Options…

Empowerment through awareness