Why I Focus on End of Life Issues in the Emergency Room [Interview][Transcript]

Dr_Kevin_Haselhorst_Wishes_To_Die_ForGuest: Dr. Kevin Haselhorst
Presenter: Neal Howard
Guest Bio: Dr. Haselhorst is an emergency medicine physician in Phoenix and the author of “Wishes to Die For,” an introspective guide to advance care planning. His views began to change after conversations with patients pinpointed the need to create smoother transitions, offering peace of mind for families coping with incurable illness.

Segment overview: Dr. Kevin Haselhorst, MD, an ER doctor, and author of WISHES TO DIE FOR, tells his story and why he decided to focus on the end of life in his work.


Health Professional Radio – Wishes to Die For

Neal Howard: Hello and welcome to Health Professional Radio, thank you so much for listening today. You know there is an old saying “Nobody gets out of here alive.” But still we find it hard to talk about end of life issues. Our guest in studio today is Dr. Kevin Haselhorst. He is here to speak with us as an MD and also as an author, the author of “Wishes to Die For.” He is an ER doctor and he focuses in his practice on “graceful departures.” How are you doing today Dr. Haselhorst?

Dr. Kevin Haselhorst: I’m well Mr. Howard. Thank you.

N: When it comes to end of life issues and the ER, there is end of life in the ER but is that something that has become the standard when it comes to emergency care? Or I thought it was more when you got admitted to the hospital?

H: Well that’s ironic, the most people don’t want to die in the hospital. But the gateway to dying in the hospital occurs through the emergency room. And so getting people more clear and even physicians more clear that if we’re providing a level of service at end of life and the patients desires to go home, we need to have that conversation in the emergency room and be able to articulate it from a place of certainty and comfort and permission because people really get permission to die. And doctors are probably one of the few people who actually give people permission to die which is heart-breaking because patients need to hear that from the doctor, and the doctor personally has a problem with that. Because it’s not something we’re necessarily trained in or have a comfort with.

N: Well yeah, your entire focus is on healing and preserving life.

H: Right, we make people better. So this whole notion about yeah, no one ever gets out alive. It was a whole conversation nobody’s goanna get out without confronting the death panel these days. Now that the Medicare is gonna pay for these conversations with doctors, my book centered around that whole aspect of me being either on the death panel as a physician or confronting the death panel as a patients. What will I say to on either side of the equation? I felt very powerless in knowing exactly what’s right and what’s wrong in having this conversation. So me… so ahead.

N: As the author of “Wishes to Die For,” let’s talk about this book. We all have these visions of a fast paced environment, there are life and death situations. But we as you said in the beginning, rarely envision an ER doctor advising patients on end of life issues, whether they’re on their way home or not.

H: Yeah well here’s my responsibility. As an ER doctor when I walk into the room, I immediately know – whether somebody who is sick or not sick, whether they’re gonna be in the hospital or be able to go home, whether they need a specialist or not need a specialist. But I will also say we also know whether or not they’re drying or not drying.

N: Okay.

H: When a patient comes from a nursing home who is at end of life, I immediately know that that patient is dying. But often times we negate that aspect of where the situation as it is. And we prolong their life or extend their life by continuing to provide a medical intervention that would certainly be questionable at best given the situation. So in the emergency room yeah, it’s a quick pace but I can pretty well tell what needs to happen. My whole thing is I do with worst case scenario and when people take a turn for the worse, I should be able to identify if this is the time to die or not the time to die for that person and then provide the appropriate care during that time.

N: Uh huh.

H: And I’ve created a lot of confusion around that by just making, trying to appease the situation or make it better when there is so much higher calling to a lot of person to past.

N: Now tell us about what was it, what happened to transition you in such a profound way and to end up becoming an author of such a book?

H: Well the breaking point was when this gentleman … a 95 years old comes in acute pulmonary edema, he can’t breathe, he’s on end stage obviously. And I do everything to try to help his breathing in terms of giving him the diuretics, some sedation, lowering his blood pressure. And he is comfortable, he is resting peacefully. And I presumed he was gonna transition at any moment because he is not to be put on a respirator. So I walked back in the room and both the nurse and the wife are both yelling at the patient “Breathe, breathe, breathe.” And I’m like “This is a sacred moment.” This should be the time when we’re guiding this person through the process, not yelling at him.

N: Uh huh. And especially such a thing, “I can’t breathe this is not you yelling breathe isn’t going to make it better.”

H: No it only frustrates him who is trying to let go and somebody is telling him to hang on.

N: Yes.

H: And I felt like at that point medicine was doing a disservice to this person. And we have got to get a better grasp of what we’re doing to people in this situation -it’s shameful.

N: Talk about the role of the advance care directives in the ER as you see it in your experience and as you describe in your book Wishes to Die For.

H: Well I see it as being a transition. I think part of the problem is we see the advance care directive as a piece of paper. And somehow it’s all knowing in terms of how our wishes are communicated. And we allow people into thinking that because they signed their advance care directive, the doctor will know how to care for this person during their in dire strides or as the situation evolves. And the choice they may have made 20 years ago may not be the choice they would make in that moment, or even last week they may have come to a different appreciation for what the end looks like. So I think the problem with the advance care directive is it’s got to maintain a certain fluidity to it because life is fluid. It doesn’t remain the same and a piece of paper subjects people to a lot of confusion, particularly for caregivers trying to make sense of it as well.

N: And where can our listeners get a copy of your book?

H: It’s available for pre-order now on Amazon.com

N: Uh huh. And you’ve got a website that gives more information about the book Wishes to Die For as well.

H: Yes, I do. It’s called www.wishestodiefor.com all spelled out wishes to die for dot com. My book is called “Wishes to Die For” but I have a brand that enrolls people in this idea of a graceful departure. So my website talks about this concepts of a graceful departure and it is but the same message www.gracefuldeparture.com.

N: Great, thank you. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. We’ve been in studio today talking with Dr. Kevin Haselhorst, he is an ER doctor experienced in end of life care. He’s been here with us talking about his book “Wishes to Die For” and also talking about the role of the advance care directive in the ER situation. It’s been great having you here with us today Dr. Haselhorst

H: Thank you.

N: Transcript and audio of this program are available at healthprofessionalradio.com.au and also at hpr.com and you can subscribe to our podcast on iTunes.

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