Ella had been fiercely independent, until at age 89 time caught up to her. She could no longer live alone, despite family help. She adjusted to her new home in the assisted living care facility. Staff were kind, food was good, and she enjoyed the ladies at her dining table. Her daughter, Megan, finally realized they had made a good decision for her care, and tearfully accepted her mom’s decision that when “my time comes, let the good Lord take me.” Megan was Ella’s health care proxy and would carry out her wishes. But she and her mom and her mom’s doctor never completed a MOLST (Medical Orders for Life-Sustaining Treatment) form delineating exactly what Ella did and did not want in the case of an emergency.
Ella awoke suddenly with crushing chest pain. She could hardly breathe. She managed to grasp the call light attached to her side rail and pressed the button. Within minutes, the night staff suspected she was having a heart attack. They called an ambulance per the facility’s regulations. The EMTs rushed into Ella’s room and quickly transported her to the nearby hospital. No sooner did they wheel her gurney into the ER, Ella stopped breathing. The hospital, not knowing anything about their new patient, initiated a full code response. They succeeded in resuscitating her and immediately placed her on a ventilator in ICU. They saved her life.
When Megan walked into ICU an hour later, she saw her mother, highly tranquilized, attached to a ventilator she knew she would have abhorred. The nurse explained that the initial CPR they instituted broke “a few” of Ella’s ribs. The ventilator was breathing for her for now. Later, when removed from the ventilator, Ella will need to breathe deeply enough, despite the pain, so she does not develop pneumonia. But for now, Ella was “doing as well as can be expected.”
The next week, Megan sat at her mother’s bedside as Ella slowly passed away.
Had a MOLST form been completed, this story would have been much different. The MOLST form is a portable doctor’s order that physically travels with the patient, unlike the traditional health care proxy. It clearly states what medical procedures are to be done and not done, no matter where the patient is. The assisted living staff would have made sure the EMTs were handed Ella’s MOLST form so they could hand it off to the ER staff upon arrival. The staff would have called Megan, made Ella comfortable, and let her “go gently into that dark night,” just as Ella wished.
That is why I call this form MOLST important. You can download it at this site. .https://www.health.ny.gov/forms/doh-5003.pdf
You would think, working in community health for years, I would have been sure my husband had a completed a MOLST form, given how often I’ve taken him to the ER.
But no. My husband had been quite ill in hospital and later was transferred to a nursing home for rehabilitation. Upon his discharge from rehab, the nurse handed me a completed MOLST form for our records. I was shocked. My husband did not recall discussing his wishes with the house physician who had completed the form, apparently in consultation with another physician unknown to us. Upon learning of this, my husband’s primary care physician was angry because he had not been consulted. I was furious because the form was completed in such a way that it was the opposite of my husband’s wishes, had he actually been consulted.
After I came down from the ceiling, I called nursing home’s director and related the experience and my concerns about it. She said it was their policy to have a MOLST form completed on all their residents, but in the future, they would be sure to have family input. How nice. The erroneous MOLST form had already been included in his electronic record. I brought a completed hard copy of a new MOLST form that reflected my husband’s wishes to the hospital upon his next admission and saw to it that it was incorporated in the electronic record.
Be sure you keep this legal set of MD orders at the ready in case of emergency. The Covid-19 pandemic is a perfect example. Sometimes family members were not aware of loved ones’ hospitalizations, and so could not speak for them.
I believe universal use of MOLST should become part of our “new normal.”