POLST
Physician Orders For Life-Sustaining Treatment (POLST)
Ruby – My Mom
The POLST form complements an advance directive by providing specific instructions that are immediately actionable by medical personnel. Emergency medical technicians (EMTs) and hospital staff are required to follow emergency medical protocols unless doctor’s orders say otherwise. Even if resuscitation or other end-of-life preferences are specified in any other document, they cannot be honored without the POLST form, at least in California.
On the day that my mom passed away, we moved her to a nursing home. When the paramedics came to my mom’s room, one looked back at me, concern etched on his face.
“Her pulse is weak. Should we give her oxygen?” His question hung in the air, heavy with implication.
Not giving life sustaining oxygen to my mom… What a cruel choice I was forced to make.
Recalling her doctor’s advice that prolonging her life at this stage is adding to her suffering, I declined. It was the hardest NO of my life.
“Do you have a POLST form for your mother?” one of the paramedics, his eyes filled with kindness, asked as he made sure Mom was comfortable.
Swallowing hard against the lump in my throat, I handed over the crisp, all-too-formal document that spelled out Mom’s healthcare wishes. “Yes, here it is,” my voice was a whisper, the words barely making their way out.
He scanned the form quickly, nodding. “Thank you. This will guide us in treating her according to her preferences.”
I watched with a heavy heart as the paramedics gently secured Mom onto a stretcher. The fading light seemed to reflect the somberness of the moment.
The ambulance doors closed with a soft thud, sealing my decision, and leaving me with my thoughts. Memories of Mom, our laughter, and shared moments flooded my mind, offering both comfort and a sharp pang of loss.
I consoled myself, recalling the conversations I’d had with Mom, her desire for dignity over prolonged suffering.
Inside the ambulance, the paramedics honored the POLST form’s directives, silently acknowledging Mom’s wishes. “I’m sorry, ma’am,” one murmured to her, a gentle acknowledgment of the journey she was on.
Driving behind the ambulance, the silence in my car was a stark contrast to the storm of emotions within me. I thought about the POLST form, the advance directive, the healthcare POA, each a piece of Mom’s voice, asserting her autonomy even as her health declined.
That POLST form, once a daunting responsibility in my hands, turned out to be Mom’s final act of self-determination, a gift allowing her to articulate her dignity and choices even in silence. As hard as the No was to Oxygen, it was an easy Yes to honor her wishes.
The Reluctant Decision
Marilyn and Marcie’s Story
Marcie sat in her favorite armchair, the one by the window that overlooked her beloved garden. The late afternoon sun warmed the room, but there was a chill in her heart. Across from her, her daughter Marilyn sat on the edge of the couch, fidgeting with the hem of her blouse. Between them, on the coffee table, lay the POLST (Physician Orders for Life-Sustaining Treatment) form.
“Mom, are you sure about this?” Marilyn’s voice was barely above a whisper, laden with concern. Her eyes filled with tears. “I just can’t bear the thought of you… you know…”
Marcie sighed, her gaze drifting to the garden. “I know it’s hard, sweetheart. But we have to be practical. My condition isn’t going to improve, and I don’t want to spend my final days in and out of the hospital, hooked up to machines.”
Marilyn looked at her mother, her heart breaking. “I understand that, Mom. But it feels like I’m losing you.”
“Marilyn, it’s about quality of life. I want to enjoy the time I have left with dignity and peace, not in constant pain and uncertainty.” Marcie’s voice was calm but firm.
The conversation had been looming over them for weeks, ever since Marcie’s diagnosis of advanced-stage cancer. Marilyn had avoided it, hoping that somehow, things would get better. But the reality was inescapable, and Marcie was determined to make her wishes known.
Just then, Dr. Turner, the family’s longtime physician, entered the room. He had offered to come by the house to help guide the conversation. “Hello, Marcie. Marilyn,” he greeted them with a warm smile, sensing the tension in the room.
“Thank you for coming, Dr. Turner,” Marcie said, grateful for his presence.
Dr. Turner sat down beside Marilyn, placing a reassuring hand on her shoulder. “Marilyn, I know this is difficult. But these conversations are so important. The POLST form allows us to clearly document your mother’s wishes for her medical care. It can provide a sense of control and peace for everyone involved.”
Marcie squeezed Marilyn’s hand. “I want to be at home, surrounded by the things and people I love. I don’t want aggressive treatments that will only prolong the inevitable. I want to focus on making the most of the time I have left.”
Marilyn took a deep breath, trying to steady her emotions. “Okay, Mom. I understand. Let’s do this together.”
Dr. Turner guided them through the form, explaining each section and ensuring that Marcie’s preferences were clearly articulated. Marilyn’s hand shook as she signed as a witness, but she felt a sense of relief alongside the sorrow. They were honoring Marcie’s wishes, and that was what mattered most.
As the sun set, casting long shadows across the room, Marcie and Marilyn sat together, holding hands. The form was filled out and signed, a tangible symbol of love and respect.
“I love you, Mom,” Marilyn whispered, her voice full of emotion.
“I love you too, Marilyn. Thank you for understanding,” Marcie replied, her heart full despite the heaviness of the moment.
In that shared understanding, they found a sense of peace. The future was uncertain, but they would face it together, with love guiding their way.
Mom’s Peaceful Departure
Percy and Sandra’s Story
Percy sat in the sterile, quiet hallway of the hospital, his mind a whirlwind of thoughts and emotions. He held a small, worn folder in his hands—the POLST (Physician Orders for Life-Sustaining Treatment) form that he and his mother, Sandra, had filled out together months ago. The doctor had just delivered the news that Sandra didn’t have much time left.
Taking a deep breath, Percy stood and walked into his mother’s room. Sandra lay in the hospital bed, her once-sparkling eyes now dull and tired, but she managed a weak smile when she saw her son. Percy approached Dr. Osbourne, who was reviewing Sandra’s chart.
“Dr. Osbourne, I have my mother’s POLST form here,” Percy said, his voice steady but filled with emotion. “She was very clear about her wishes.”
Dr. Osbourne took the form and reviewed it carefully. “Thank you, Percy. This helps ensure we honor Sandra’s wishes during this difficult time. I’ll make sure the team is aware of her directives.”
Percy nodded, feeling a mix of relief and sorrow. He moved to his mother’s bedside, taking her frail hand in his. “Hey, Mom.”
Sandra’s smile widened slightly. “Hey, sweet boy. How are you holding up?”
“I’m here, Mom. Just like always,” Percy replied, his voice cracking slightly. He pulled a chair close and sat down, not letting go of her hand.
They sat in silence for a few moments, the weight of the situation settling around them. Percy looked at his mother, the woman who had been his rock, his guide, and his biggest supporter. He felt a pang of sorrow, knowing their time together was drawing to a close.
“Remember that time we went to the beach and built the biggest sandcastle ever?” Percy asked, breaking the silence with a nostalgic smile.
Sandra’s eyes sparkled with the memory. “Of course, I do. You were about six years old, and you insisted it had to have a moat. We spent hours perfecting it.”
Percy chuckled softly. “And then the tide came in and washed it all away. I was so upset, but you told me it was just a chance to build something even better next time.”
Sandra squeezed his hand weakly. “You’ve always been such a determined boy. Never let anything keep you down for long.”
They laughed softly, the sound a balm for their aching hearts. Each memory they shared strengthened the bond they had forged over the years, a bond that no illness could break.
As the night grew darker, Percy felt a profound sense of gratitude for these final moments with his mother. He leaned in closer, resting his head gently on the edge of her bed. “I love you, Mom.”
Sandra’s voice was barely a whisper, but her words were clear. “I love you too, Percy. Always remember that.”
Percy stayed by her side through the night, recounting memories until Sandra drifted into a peaceful sleep. He held her hand, knowing he had honored her wishes and given her the comfort she deserved in her final moments.
When the time came, Percy felt a deep, aching sadness, but also a sense of peace. He had fulfilled his mother’s wishes as she had fulfilled his. The POLST form had guided them through this difficult journey, ensuring that Sandra’s end-of-life care was exactly as she wanted it to be.