A year ago Tairāwhiti nursing leader Dr Heather Robertson had started work on a draft advanced care plan when she had a traumatic car accident. She shares some hard won advice and thoughts on advanced care planning.
In August 2015 I had a car accident in Waikato that resulted in multiple injuries: a broken neck, pelvis and lumber spine. I also suffered a brain bleed, a torn artery going into my brain and a small tear in my spleen.
As a nurse, I strongly believed in the benefits of thinking ahead and deciding what matters the most to me. I had recorded this by completing the first module on the Advanced Care Planning website (NZ) .
So I had a draft advance care plan on my computer. As it turned out it wasn’t much good sitting there. I hadn’t had the opportunity to talk to my two older children because they lived in Australia and I was waiting until they were all home together so I could discuss my advance care plan with them. I never had a copy at home with me.
Then I had a car accident.
I had no knowledge of what happened to me for 10 days while I was in Waikato Hospital. I was unconscious at the accident site. I regained consciousness but wasn’t fully participating in my health care decisions. Fortunately my eldest daughter, Jade, also a nurse, knows me well and knows what I would want and would not want. She was able to speak on my behalf.
On one occasion I signed a consent form for an operation to fuse the bones in my neck. Most likely it would have permanently limited my neck movement. I have no recall of this and wouldn’t have signed the form so readily if I was mentally competent at the time. My daughter did challenge this but was ignored.
Luckily because of some of my other injuries they couldn’t proceed with the operation. Once I did become mentally competent I would have been furious this had been done.
When I was stable I was transferred back to Gisborne Hospital. I wasn’t out of the woods yet so I quickly asked a nurse to download an advance care plan form. I filled it in and kept it on my bedside locker.
This was a conversation point with a number of people, some even mocking my need for such a plan. I am glad it never got tested, but hope that the advance care plan would have been used to guide my treatment if I were incapable of making decisions for myself. I value my independence and being a burden on my family long-term is not an option for me. If I end up brain damaged, paralysed, or requiring long term care, I don’t want to be actively treated.
I still have that same advance care plan, it sits at the end of my bed at home just in case. Some people have asked if my thinking about what is important and not important of me has changed since the accident. It hasn’t. Making an advance care plan was a journey of thinking, talking and deciding what matters to me. Because I had thought this through, my values and beliefs remained the same.
I acknowledge sometimes it isn’t easy to talk to family about this but it is really important. I am very lucky to have an understanding daughter who knows me well enough and I know she would respect my decisions. When I was developing my plan prior to the accident I spoke to my friend and colleague, Penny Forrester, about what matters most to me. Once I was mentally competent after the accident I asked her to support my daughter if she is ever required to make some of the difficult decisions. I understand how hard and emotional this would be.
I also have my will and personal files, banking details etc printed off and I will keep my advance directive with these. I have shown my daughter where these are now kept. What the accident and the journey that followed have taught me is that you never know when you are going to need it. We all think that an accident will happen to someone else - not to me.
Talking to family about what medical treatment we would want before we need it makes decisions less stressful to our family, our children, and our loved ones. It is a gift to our family that we can share with them now.
Dr Heather Robertson is on a return to work plan for her position as Nurse Leader Primary and Community Care at Hauora Tairāwhiti in Gisborne. She has a background in public health nursing and in 2014 completed her doctorate thesis on how implementing the government’s Primary Health Care Strategy impacted on the primary health care nurses in Tairāwhiti.
NB This article was written for and released by Hauora Tairāwhiti (Tairāwhiti District Health Board)
CAPTION: Dr Heather Robertson (left) in the Orthopaedic Ward at Gisborne Hospital where she spent some of her recovery time. Hannelie Fourie (right) is the Clinical Nurse Manager who helped to care for Heather.
PHOTO CREDIT: Gisborne Herald