The Green Envelope On The Fridge...

A couple of week's ago Tess had a check up with her pulmonologist at Maine Medical Center. Knock on wood, the kid has had an amazingly illness free winter in an almost too good to be true fashion. Her doc was very happy with how she was doing, we adjusted some daily breathing treatments, and then things turned pretty serious. 

He asked me if Tess had had the flu vaccine this winter and I replied absolutely, she had it at the beginning of November (which was a little late for her but with moving off the island, we missed the island clinic one).  The doc was happy to hear because, as we all know by now, this year's flu season has been more deadly than most and children like Tessie are hit the hardest. 

I told the doc that I had a huge fear of Tess getting this flu in particular due to everything I'd been hearing about the deadliness of it and then asked if he thought I was overreacting with my fear of it. 

The short answer? No. I was not. 

I then asked the question that haunts my nightmares. If Tess does get this flu, did he think she would survive it. 

The short answer. Again, no. 

ARGH! 

Now before anyone starts to think this guy is a big jerk with no bedside manner, I can assure you he is actually an amazing doctor with a huge heart for these kids and their families. He had even fit us in on a day when he doesn't normally see patients because he wanted to be able to spend an hour and a half with us. Like, he had literally blocked that off in his calendar. He's a good doc and more importantly, a good man. 

What he did say, and which I already knew in my heart, was that the chances of Tess surviving this flu were very slim. Especially since Tess's lungs and body have already been throughs so much so it's just not the same as a healthy child getting it. And, even seemingly healthy kids were dying from it. 

This led to him bringing up the topic of an Advanced Directive for Tess and if we had one. He knew we had met with Maine Medical's Palliative Care nurse a couple of times in the past and had even filled out paperwork called  My Wishes that does deal with end of life care and what that might look like for your child. 

When he asked if Tess was still a full code I very emphatically responded with, "YES!" I want every measure to be used to try to save her if she crashes. 

He looked at me very kindly and asked me gently did I fully understand what that meant? I was confused by the question because, hello! Of course I knew what it meant....CPR, many, many meds, possible life support (temporarily until she gets strong enough to breathe on her own again), etc.

He then asked me if I knew just exactly what CPR entailed. Well, I have watched an awful lot of Grey's Anatomy and have taken several CPR courses so, yeah! Of course I knew.

Except I didn't know. Not really.

CPR would be painful. Chances are they would break her ribs and sternum. They would push cardiac meds. And if they did manage to restart her heart, chances were very good that this would not be an isolated incident. That it was a sign of her body truly wearing down and would happen again. Maybe not that day or week, but also not too far off.  He also said that if they got Tess back, she would most likely need much more help medically speaking than she does now. If Tess ever needs life support due to an illness, that most likely she will never come off of it and would have to live the rest of her life hooked up to a ventilator in order to live. He then added, "And we don't know if we get her back if it's going to be the same girl you know now and in all honesty, I don't think it will be." 

I was just shaking my head no the whole time he was talking. No way in hell was I going to allow anyone to hurt Tessie even if it was because they were trying to save her. Not after everything she's been through and would have gone through to get to that point of needing CPR. I couldn't imagine intentionally inflicting more pain on her. Not on my watch. And the bottom line for me, for us, is Tess has EARNED the right, when her time does come,  to pass away with ease and as much dignity and comfort that we can give her. She deserves it. It would simply be selfish of us to allow anything else. When I told the doctor that I also said that I can't imagine ever signing a DNR on her. It's like saying "I give up" and I will never give up on Tessie. 

He told me there was a form that we could fill out that was a step by step of what we would allow for crisis care for Tess and that we could tailor it to say whatever we wanted.  He felt, given the crazy flu season and Tess's fragile health, that we shouldn't hesitate to get one filled out so that it would be in all of her doctor's computer systems and we would have a copy as well. After that, he set up an appointment for us with Palliative Care again and, after dropping Tessie off at school on Monday morning, we went to fill out that horrible, but necessary, piece of paper. 

Charlie and I have always said that the quality of Tess's life would always be the most important thing. Tessie has a good life. She loves her life. Her family. Oreo. Her school and friends. If she gets so sick that those decisions do need to be made, then Charlie and I have made them together with only that in mind. That Tess deserves whatever is best for her. Not us. If it was up to me, I would say DO EVERYTHING JUST SAVE HER! But that would be selfish. That would be for me, not for Tessie. And that's just not fair. 

In the end Charlie and I opted for a modified Full Code. Do everything you can to save her but no CPR or cardiac meds are to be given. We will  not have her hurt even more during a time when she will already be suffering and needs us to be strong for her. We will have her use breathing support if the doctors believe she has a chance of surviving as well as any and all other meds that could help her but that's where we are drawing the line. At that point it will be up to Tess and God. 

And I pray we have the courage and strength to remember this if and when this terrible time ever comes. 

In the meantime, the Advanced Directive sits in a green envelope that's hanging on our fridge because apparently paramedics are trained to look for them there. As you can imagine, having that staring at you everyday and knowing what's in it brings it's own heartache but I think the bigger heartache would be dishonoring Tess in any way. 

But it also sits next to happy things. Life affirming things like Blake and Bobby's Christmas Card and Ellie's Dean's List paperwork along with, on the other side, an art project of Tessie's. 

So the green envelope's heartache is lessened with daily reminders of the good stuff in life along with the hope and prayers that it will not need to be opened for a long, long, long time. 

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