It’s strange filling out your health care proxy and living will at the age of 26. The questions that are asked seem to be issues that I shouldn’t be considering before I’ve gotten married, had kids, gained 40 pounds, overcome three to four mid-life crises and become a registered Republican. But, tomorrow I will be undergoing the surgeon’s knife, so here we are.
The New York Health Care Proxy and Living Will is six pages long and there are three parts. It can be found by consulting your favorite search engine and “meshed terms” are not necessary. As an aside, I think I’ve used PubMed a total of four times and it remains the blackest of boxes that ever existed in my life.
Part 1: Health Care Proxy
I, (insert name here), hereby appoint: ____________ as my health care agent.
After thinking about it for a full 10 seconds, I decided to make my health care proxy my younger brother. When I asked the chosen brother, he paused like he so often does, mulling the question over in his mind, rapidly analyzing the pros and cons — an engineer’s brain at work — before formulating a simple affirmation. I swear I don’t love the chosen brother any more than the un-chosen brother, but there’s a reason it took me as little time as it did to decide. I appreciate his thoughtfulness, empathy and his innate ability to choose the right thing no matter the situation. If, for some reason, after the final count was correct, the sutures were knotted, the anesthetic gas turned off, my operation were over and I were never to wake up again, I’d just as easily miss my un-chosen brother’s bravery, commitment to the marginalized, and the unerring conviction for what he believes in. Shit, writing about not coming back and being their big brother makes me so sad I could cry.
In the event that the person I name above is unable, unwilling, or reasonably unavailable to act as my agent, I hereby appoint ___________ as my health care agent.
In would step my dad, the health care proxy backup. Being backup isn’t so bad. Aaron Rodgers was once a backup to Brett Favre. Look at him now. He’s won a Super Bowl, starred in some State Farm commercials that I laugh way too hard at and dated Olivia Munn. Not bad at all. I’m supremely unsure if my father’s arthritic right shoulder could lead the Green Bay Packers to Super Bowl glory or about his ability to peddle insurance. And, despite the fact that he used to resemble one of the Beach Boys, his days of dating beautiful, high-profile women are over. Also, have you seen how the Beach Boys look nowadays? Yikes. What I am supremely sure of, though, is his love for his family, his unshakeable faith and his belief that despite everything going on poorly in the world, things will turn around. It certainly helps him to have my mother. She is a 5-foot, 1-inch, Vietnam War refugee, tiger-mom who, after 26 years of parenthood, will finally end a phone call with an “I love you.” She laughs so hard at her own jokes she makes herself cry and is without a doubt the strongest person I’ve ever met. To these two, I owe mostly everything. I’ll spare them the responsibility for my sense of humor, though. That, I know, neither wants.
My family is not perfect. We’re perpetually late to extended family gatherings, our communication needs work and we shun the topic of politics to avoid getting into physical altercations. But each member is the most forgivable person in my life. Maybe that is what being family is all about: forgiving each other over and over and over again. I know each member would gladly take my spot in the operating room chair. I am more than happy to do it, knowing that none of them will have to.
This health care proxy shall take effect in the event I become unable to make my own health care decisions. My agent has the authority to make any and all health care decisions for me …
Part II: Living Will
“I, {insert name here}, being of sound mind, make this statement as a directive to be followed if I become unable to participate in decisions regarding my medical care.”
After this rather self-aggrandizing statement (“Sound mind”? Ehhhh. Since third year of medical school began, nothing could be further from reality), you are provided with two options:
Initial only one box
_____{a} Choice NOT to Prolong Life
_____{b} Choice to Prolong Life
Before offering you my selection, let me preface this by saying, I’m a practicing Catholic. Okay, maybe I’m not a 100% every Sunday church-goer, but I’m at least 75%. Based on twelve years of Catholic schooling, I’m pretty certain that I should choose the latter option. But, I’m also a pretending-to-know-what-I’m-doing third-year medical student. And, like most other medical students in the world, I’ve lived with patients and their families as they have suffered and died around me. Suffering isn’t inherently a bad thing. Sure, it might make you more abrasive, pessimistic and nihilistic. But, it also makes one stronger, more appreciative, more humble and more whole. A little dose of suffering is experienced by any individual working in health care. The struggle is finding the tools to mold that suffering to where it can provide oneself with greatest perspective. I am still working on that.
Once, a palliative physician told me that when she was consulting a family about the futility of further treatment and to consider palliative options to prevent a patient’s further suffering, the patient’s spouse responded, “This is America. We don’t give up here.” I imagine the Navy Blue Angels performed an impromptu fly-over with the last notes of “America the Beautiful” fading away as she uttered those words. Is it unpatriotic to give up? Does it make oneself weak to know when the fight is over? What would John Cena do?
The only thing I have come to know in my first three years of medical school is that I do not know anything. I simply try my best (on most days — some days I just cannot), study, observe, learn, experience and hope that, when it is my turn, my educated guess will be the right one. And, reflecting upon the multitude of experiences and the families and patients I have met, I believe it best not to prolong life when my suffering is unnecessary and for no gain than it’s own end. I initialed “NH” next to {a}.
My agent should also consider the following instructions when making health care decisions for me …
… Followed by a large section of blank space. Wow, well, this next part could really go anywhere. Although I’ve been in medical school for three years now, and seen a wide array of decisions both good and bad made in the setting of end of life care, I still feel my written answer is immature and clunky. For someone who has seen his fair share of suffering and death, I really hoped I could come up with something better than four bullet points:
– Avoiding unnecessary suffering.
– Catholic background/faith context.
– Desire to be cremated.
– Input from all members of the nuclear family.
That was it. Twenty-six years of living and — if you believe it — everlasting life ahead of me and I wanted that gateway towards eternity to be summarized in four bullet points, totaling 22 words. Was I really as simple as that?
Let me get real for a brief moment. Medical school has beaten me down. It has made me into a less happy version of myself. It has made me feel small, impatient, cynical and it has certainly led to a couple mental breakdowns. But, like everything in life, it also has its positives. The best thing about it? Hmm … instilling a knowledge that happiness is life’s ultimate goal, clearly illustrating what I both hate and love in my peers, providing me with the tools to tangibly help those around me, giving me the realization that I have strength and the fucking work ethic to do whatever life throws at me. Those are all big benefits. One stands above the rest though: It has made me abhor situations where small talk is likely to happen. No, I don’t want to talk about the exam. No, I don’t want to be preached about study strategies over a beer. Yes, I really would rather do anything than hear about upstate New York weather again. Upon reflection, I think 22 words deciding the rest of my soul in perpetuity does quite nicely.
These directions express my legal right to refuse treatment, under the law of New York.
Optional Organ Donation:
Upon my death: (initial only one applicable box)
___{a} I do not give any of my organs, tissues, or parts and do not want my agent, guardian, or family to make a donation on my behalf
___{b} I give any needed organs, tissues, or parts
___{c} I give the following organs, tissues, or parts only: _______
Easiest question of the bunch. Go ahead and use my organs, tissues or parts for transplant, therapy, research or education. I don’t mind sharing my hopefully smooth liver or well-hydrated kidneys. Being able to cure someone even when I’m dead would be neat. I’ve avoided hard science research like the plague while alive — might as well get my experience in while lifeless. Most importantly, though, my corpse could be the receptacle that a future medical student can lose his/her scalpel in. In death, I’ll no longer be able to do those things I love: play soccer, read about history, gorge myself on sushi, go for a hike or love my friends and family. The least I can do for the next generation of patients and hopefully less jaded and far funnier medical providers is to be useful.
Part III: Execution.
Sign and date the document.
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4/4/18
Well, that is it.
It’s currently 11:50 p.m. and I will be NPO (nil per os) at midnight. My surgery is scheduled for noon. Time for what may be the final meal of my existence. What could be better than a last supper of four Rice Krispie Treats and two packs of Welch’s Fruit Snacks?
Surviving my operation.
Contributing Writer
University of Rochester School of Medicine and Dentistry
Nate is a third year medical student at the University of Rochester School of Medicine and Dentistry. When he's not getting pimped on the floors and supplying incorrect responses, you can find him playing soccer, reading about anything but medicine, and dreaming of adding another stamp to his passport.