Sometimes, the best approach in a health crisis is to do nothing

When a loved one is dying, everyone wants to do something. Everyone fears doing nothing.

But if people examined their assumptions, they might come to realize that, sometimes, doing nothing is in fact doing something. And not just something, but something wise and kind.

I am a nurse who works in intensive care. This is what I usually see:

Families and patients ask the doctor for options. The doctor offers some, and winds up ordering tests and treatment. Meanwhile, the patient's comfort takes a back seat to the quest for a cure. People don't understand the limits of medicine. Doctors don't always explain risks and benefits clearly. Patients and families may fail to grasp the truth -- that the pursuit of a cure is not going to succeed -- and take comfort in the notion that doing something must always be better than doing nothing. It's not.

Once they understand the value of doing nothing -- or at least doing nothing to prolong the inevitable -- then the patient, the family and the medical team can concentrate on helping the patient to be comfortable. Seen in that context, seeking more treatments and tests is worse than doing nothing.

My grandfather is a case in point. He is a retired farmer who was proud, at 65, that he had bigger biceps than any of his progeny.

Now in his 80s, he has had three near-death experiences in intensive care. My 86-year-old grandmother cares for him. She does not -- dares not -- leave his side. He can't put on his own clothes or get himself a glass of water.

He repeatedly says it is no way to live and he wishes he could just die.

Did all of the money that was spent to save him those three times buy a life that he and my grandmother would consider worth living?

If they had been given a more comprehensive view of what his quality of life was likely to be after the procedures he was about to undergo, they might have chosen a different path, one that would have led him to die sooner but with more dignity.

Here are a few ideas for providing better outcomes for patients and their families:

1. Offer Medicare patients an incentive to write their own health care directives. This will help families and doctors understand what the patient's end-of-life wishes are. It will also prevent patients from having to endure treatments they do not want.

2. Help doctors learn better ways of communicating the risks and benefits of potential treatments and tests, and better ways of delivering end-of-life care. Plenty of helpful information is available from the Mayo Clinic.

3. Work to change society's views about end-of-life care. We need to learn that quality of life is more important than quantity of life. This can't be legislated; it can happen only through public debate and education.

I am not proposing that we artificially limit health care resources for the elderly sick. But I have seen too many people suffer needlessly at the end of their lives. Somebody should have told them what they were getting into.

I am also not offering advice that I would not take myself. My four years of caring for people in extreme health crisis -- many of them at the end of their lives -- have given me a clear view of what I want for myself when my time comes.

For example, if I am diagnosed with Lou Gehrig's disease, I will not spend a minute of my remaining life span fighting to be cured. There is no cure.

I will start researching hospice programs in my area and pick the very best one. I will update my health care directive and add a list of ironclad rules for my family to follow -- when NOT to call 911, put me in the hospital or put me on a ventilator.

After I get a "do not resuscitate" order from my doctor, I will have the words tattooed right above my heart. Then I will sit back, relax and do nothing -- nothing but enjoy the rest of my life for as long as God gives me.

That's what I want, and I've made sure my family knows that's what I want. Because if they don't do as I've asked, I will find a way to embarrass them from beyond the grave. They know I can do it.

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Julie Hendricks, R.N., works as a critical care nurse in a Duluth Hospital.

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