A Patient's Guide on Keeping your Voice

A few weeks ago I had the pleasure of taking care of a very spry 89 year old man who suffered from a stroke. For those of you who do not know what a stroke entails, let me explain. There are two different kinds of stroke; Ischemic and hemorrhagic. Ischemic is where you have a blockage in an artery preventing blood flow to parts of your brain and hemorrhagic is when one of those arteries breaks and bleeds into your brain. Both of these can be potentially life threatening. This young man suffered from an ischemic stroke and was fortunate enough that his wife recognized the symptoms and called 911 immediately. We were able to remove the blockage in his artery and he eventually gained full function again (this is not always the case, believe me). Prior to this man's recovery he suffered from what we call expressive aphasia; this means that he is able to understand what you are saying and also form his own thoughts, however when he tries to speak, the words come out garbled. This man has lost his voice, literally. He has just found himself in a very vulnerable situation and unable to communicate his wants or needs. Now there are multiple ways, especially in the ICU that you can lose your voice. You can be intubated on a ventilator (breathing machine), you can be sedated with drugs, if you are elderly sometimes your family members will automatically assume you cannot make your own decisions even if you are of sound and mind and speak for you, you can be an alcoholic or drug addict going through withdrawal and be totally out of your mind, or you can have a doctor or nurse who just doesn't listen to you. So what can you as a patient do to keep your voice while in the hospital?

1. Prepare a living will or five wishes form before you get to the hospital. If you do not want to be put on life support and have feeding tubes, and other tubes (we have a tube for everything nowadays) put into your body and be left in a vegetative or bed bound state for the rest of you days then please write this down. It is not fair to your loved ones to leave them with this decision. I know that some people will state that they do not want to live this way and they do have this discussion with their spouse but that is not good enough, it must be written down. Here is a link to download the five wishes form http://www.agingwithdignity.org. This is the easiest way to let your medical providers and family members know your wishes. You can also ask for a living will form from your local hospital or download it off the Internet as well. 
2. Designate someone to advocate for you if you are unable to speak for yourself. You can do this by obtaining a medical durable power of attorney. These forms are state specific and can be downloaded from the Internet. To make it legal just have it witnessed and notarized. Try to choose someone who is not intimidated by medical professionals, who can ask challenging questions and who can put aside their own feelings in order to ensure your wishes are carried out. 
3. If you find that your doctor or nurse is not listening to you, ask to speak to the charge nurse or patient advocate in the hospital. Tell them your concerns, calmly, and maybe they can help address them. If this doesn't work you can always resort to firing your nurse or doctor. You have what we call patient rights and that's one of them. 
4. For some reason when elderly patients come into the hospital, people, including family members, tend to treat them like children. Do not let this happen to you and try not to do this to your family member. If you or your loved one are capable of making decisions then it would be best if they were involved in the decision making process. I have seen many occasions when patient's family members push a medical intervention on them just to show that they are not "giving up." 

It is always best to have these discussions before entering the hospital system. Being a patient can be one of the scariest and most challenging events in a person's life. Making decisions under this amount of stress can just make situations more difficult. I know thinking about and addressing end of life decisions may seem like a far fetched way to spend your free time but the truth of the matter, is that death is inevitable and cannot be predicted. People's poor dietary and lifestyle habits are causing them to be more sick and at higher risk for disease and death at a younger age. Take the time this week or month to talk with your loved ones about end of life decisions. While your at it, may talk to them about their current life decisions as well:)