Transportation experts estimate that 107 million Americans took the annual trek over the river and through the woods to Grandmother’s house. They opted out of the sleigh and jammed the nation’s airports and interstate highway system to join the national quest to retrieve the past.

How did we get so scattered across this land? After all, the institutions of home and family and community are strong and compelling. They are a source of security and identity. They define us as individuals, set out early in life our responsibilities to others and our expectations from them, not just laws and rules, but a familiar culture that shapes us and our neighbors -- for better or worse.

Happy New Year!

You’ve now had one week to think about whether your new year’s resolutions are practical, attainable, a bit lofty, or just ridiculous. Or maybe you decided not to make any, in which case you can’t let yourself down.

I’ve heard it said that it takes three weeks of a new routine in order to make it a habit. So, for those of you still working on it, hang in there. Two weeks to go!

A friend of mine said recently that we should stop making resolutions; they just set us up for failure. Maybe we decide to just make one small change. For example, no eating after 7 p.m.; or, electronics off at 9 p.m., only reading allowed after that; or, simply, fancy takeout coffee only on Wednesdays…

If you’re looking for an object lesson on the value of getting expert guidance when tackling a new adventure, look no further than the annual middle/high school holiday band concert.

Excited sixth graders with shiny new instruments take the stage and, with shuffles and squeaks, tune up for their first concert. Toes tapping deliberately, they methodically plod through a few holiday tunes in unison. With just a few months of instruction, they’ve gone from learning to read music to performing in front of a packed house. It’s fun to watch their pride mixed with relief at getting through the big event.

Questions and Answers

  1. My son wants me to get an advance medical directive.  I already made a living will a few years ago, isn’t that enough?

 

  1. A Living Will is a document that tells others, your doctors and family, what type of medical care you would like to receive should you become terminally ill or permanently unconscious.  It can advise whether you do, or do not, want such things as a respirator or feeding tubes to be used, or measures such as surgery, or experimental drugs or treatments to prolong your life.  In Michigan, there is court precedent that a living will is a legally binding document, but there is not a law stating this.

An Advance Medical Directive goes a bit further as a legally binding document in which you appoint who you want to make medical decisions and what your end-of-life wishes are if you become unable to make medical decisions on your own.  This Patient Advocate, or Durable Power of Attorney for Health Care, has the responsibility to make a reasonable effort to ensure your instructions are followed.  A living will, then, can explain what your wants are, but an advance directive states who will make sure your choices are implemented.  It can be a more flexible document because your patient advocate has the ability to respond to unexpected situations.

Another legal document that can be completed, often in conjunction with a living will or an advance directive, is a Do Not Resuscitate Order (DNR.)  A DNR indicates that no one take measures to revive you if your heart and breathing stops.  If this is a choice expressed in your living will or advance directive, it might be useful to have a DNR as well, since a person can be competent up to the moment that death occurs, in which case a living will or advance directive would then never take effect.

There are numerous online resources and blank forms for use in completing a living will, advance directive, or DNR.  Area Agency on Aging Region IV’s resource library also has forms available.  Stop by, or call our Info-Line at 800-654-2810 if you would like something sent to you.

  1. My mother-in-law, who lives in another state, is terminally ill, but is hoping to attend our daughter’s wedding two months from now.  She has had a do-not-resuscitate order for quite a while, but says she now has a “physician’s order for scope of treatment” document that can override the DNR order, temporarily.  What exactly is this?

 

  1. The Physician’s Order for Scope of Treatment (POST) document is a newer legal form, for which laws have just recently passed allowing for its use in Michigan.  Also known as Physician’s Order of Life Sustaining Treatment (POLST) these forms originated in Oregon in response to that state’s assisted suicide law, and have been in use in several other states as well.

The National POLST Paradigm Program Task Force states that POST or POLST forms are not advance directives, but rather portable, actionable medical orders.  These orders are for the treatment of a specific condition, which direction could include end-of-life choices.  They have a limited time frame and limited function, designed to be an advance care planning tool for seriously ill individuals whose health care professionals would not be surprised if they died within a year.  These forms are completed after discussions between a health care provider and the patient (and/or the patient advocate) in which the physician details diagnosis, prognosis, and treatment options -- including benefits and burdens of each --and the patient shares his/her values, beliefs, religious and ethical concerns, and goals of care, which might include personal life goals based on current circumstances.  After this informed, shared decision-making process, the treatment plan is documented and the POLST form is signed by the physician.

My father was an aeronautical visionary. In WWII, when a small plane was needed to fly supplies into and wounded persons out of remote areas with hardly any landing space, a design competition was held. When engineering teams presented their creations to see which could land and take off in the shortest strip of runway, my father’s team landed the runway crossways. His Stinson L5, “the Flying Jeep”, hangs in the Smithsonian today. I didn’t inherit that gene.

Dereck Thompson, a writer for The Atlantic, recently wrote of interviews conducted within Google’s “Moonshot Industry”. This portion of the company is devoted to what they call radical creativity, exploring breakthrough technology to address huge societal problems.

The state of the medical insurance industry in our nation, as it exists right now, seems to make no one in Washington, D.C. happy.

Why can’t they find some middle ground? Well, mostly because the premises of each side are incompatible with those of the other, so there is little common ground on which they can stand to reach an understanding, in spite of the fact that every other advanced industrialized nation, as diverse as Switzerland, Germany, Canada, Singapore, and Japan, has found a way.

So, we know we can’t be friends with everyone. Sometimes it’s hard just to be kind to some acquaintances. Then again, it’s possible to love people that you don’t really like.

Around the holidays, it seems that all those things are exaggerated. Whether it’s work, church, home or extended family, we are bombarded with amplified social obligations. So, when we’re struggling in any relationship those issues can become larger than life.

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