But of course, every one of them is a "cash cow" and great for business.I'm not so sure about that, especially since so many are on Medicaid. I've visited nursing homes where every patient's chart had a DNR prominently posted on it. Besides, it's not the nursing homes that are keeping them alive, it's the miracles (irony alert) of modern medical science.The sad reality is that doctors are trained to cure, but they haven't been trained to cope with their 100% failure rate. They don't know how to give up, and if the patient, alone or through people who have been told, doesn't say "enough" they'll continue to chase whatever the current problem is.A living will isn't enough. While you're still temporarily able-bodied you need to talk to those people who will speak for you if you can't speak for yourself. When my mother's Alzheimer's progressed to the point that her body "forgot" how to swallow, I had no problem telling the doctor to drop dead when he suggested a feeding tube since I knew my mother would haunt me at least until I was dead if I let them do that to her.Big dramatic things like ventilators and feeding tubes can be pretty obvious, but it's the little things that add up that you really need to talk about. My epiphany was after my 89 year old mother fell into my bathtub on Christmas evening. Several weeks later her doctor wanted an EEG, "just in case." As I was driving her to the test she repeated "I want to go home."It got me to thinking about why we were doing the test. We're going to do brain surgery on this woman? I don't think so. We had already discussed the issue of comfort care, and I was quite comfortable in saying that we were now at that stage. The assembled family agreed, although I have to admit that my father didn't want to give up. I consider one of the greatest gifts I gave my mother to be keeping her away from the tubes that I think he would have, on his own, subjected her to.These conversations are never pleasant, but if the day comes that someone will have to speak for you, it will be a lot easier if you've talked about it.Phil
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