My mother had a heart atta ck on my birthday. Well, maybe a few hours before my birthday but it was picked up on my birthday and my father took her in to the Milford Medical Center where they determined she needed to go by ambulance to St Joseph’s Hospital. She is on the cardiac unit there and so far we are thrilled with the care she is receiving throughout this significant “event.”

In addition to the medical care that seems outstanding, the caring itself is remarkable. In particular, the care the doctor took in walking my father and mother through a “do not resuscitate” order is noteworthy.

We all have a tendency to avoid thinking of the circumstances of death. My grandmother died at 80 a very healthy woman who was blessed to just close her eyes and not wake up in the morning. No suffering. No limping along with one organ after another slowly quitting. I was 22 years old and I know that I decided right then that was how I would die. Neat and clean and no decisions to make. But this is not how it always works.

My parents have approached being seniors and aging with a fair amount of planning. They arrived in New Hampshire from Florida with a beautiful binder from their attorney labeled “Estate Planning Portfolio.” The majority of Americans do not make end-of life plans, in fact about 80% of people do not preplan and prepare advanced directives.

When questioned about whether they should do CPR if my mother’s heart stops, my father said “We have a living will. We do not want to live hooked up to tubes. Judy would you bring the doctor a copy?” As his child and as a Certified Senior Advisor, I thought great, this discussion has happened and we are all set. But did it really happen? Is there really an understanding?

Maybe not.

An advanced directive has 2 parts, a durable power of attorney for health care and a living will. A 3rd part that may be necessary is called a Do Not Resuscitate order or DNR. This portion lets medical personnel know if a patient does not want action taken to resuscitate them in the event that their heart stops. A living will speaks to the care desired when a person is considered terminal.

In my parents case they had designated me as their durable power of attorney for health care but this was the first I was hearing of their actual wishes. In addition, when questioned, although they have a statement about not wanting to live hooked up to tubes and everything, and I heard both my father and mother say this to the doctor, when further questioned, they said yes, they did want CPR started. It suddenly became clear that they did not understand DNR.

AS their durable power of attorney it is essential that I understand their wishes as they approach the end of life. But even more important is that they understand this stage of life, the circumstances that bring us to the end of life and how decisions today will change the face of our last days, months or years. Given medical advances, once CPR is started we may be able to live a prolonged but difficult life that we never intended.

The doctor gently described to my parents the likelihood of broken ribs and decreased oxygen to the brain during CPR. That my mother may live but may not be the same person she is today. Neither she nor my father want that and as difficult as it was, they were able to state this clearly to the doctor, the nurse and to me. My mother is now wearing a purple bracelet that also tells everyone else her wishes. She will not be resuscitated if her heart stops.

It is important for me to be clear. My mother has had 40 plus years of rheumatoid arthritis, 2 strokes, removal of ½ of her right lung, confusion (not yet diagnosed dementia but with all of the characteristics) and a heart attack. She is not the oldest of old but she is old at 80. She is a wonderful woman who is loved by everyone who meets her. She is nicknamed “Sweet Priscilla.” We love her so much we want to honor her wishes about how she wants to live out her life.

This is her decision. You will have yours, your parents will have theirs. Talk about it. Sooner rather tan later. Be clear. Be supportive. We have been grateful to have a doctor hold our hands through this before it was too late.