Palliative Care and Pain Suppression in Thailand

[Sheryl]

2 hours ago, Pilotman said:

I didn't know that.  he has had an ultra sound and the Drs seem quite sure that it is Cancer, but I will bring that up.  he is back home now after having fluid drained and in slightly  less pain. 

The fluid will keep re-accumulating and they will have to keep bringing him back and forth for this.

 

Did they clearly tell the doctors that the pain medication is insufficient?

 

Between the need for frequent paracentesis (draining of ascitic fluid) and  likely need for injectable morphine he would be best off hospitalized and they should push for this, telling the doctors his pain is not relieved by oral medication and they cannot manage him at home.

 

 

 

 

[kokesaat]

First, I apologize for the poor quality of the photo.  It says "The Orchid Nursing Home and Long Stay".  It's 17km from the center of Udon.  Although it's still not open, there has been recent activity there, moving hospital type beds and such.  One village official told me they are hoping to provide a medium-level (cost) type of facility that will cater to upper class Thais and foreigners, especially Japanese and European.

I realize this doesn't do anyone in need today any help.....but it's a ray of hope for those in the Isaan area who are looking for such a place.  I'll keep everyone posted as I see further developments.

 

[Pilotman]

4 hours ago, Sheryl said:

The fluid will keep re-accumulating and they will have to keep bringing him back and forth for this.

 

Did they clearly tell the doctors that the pain medication is insufficient?

 

Between the need for frequent paracentesis (draining of ascitic fluid) and  likely need for injectable morphine he would be best off hospitalized and they should push for this, telling the doctors his pain is not relieved by oral medication and they cannot manage him at home.

 

 

 

 

He died just now (3/9/17 at 4pm). very sad and a wake up call  for all of us regarding poor palliative care in LOS.  It has also told me that I need an exit plan for when the inevitable happens. 

[Sheryl]

My condolences

[Thanyaburi Mac]

kokesaat

 

Please keep the board posted when it opens.

 

I note additional photos on Facebook:  tinyurl.com/yb9367ud

 

Mac

[connda]

On 9/3/2017 at 4:39 PM, Pilotman said:

He died just now (3/9/17 at 4pm). very sad and a wake up call  for all of us regarding poor palliative care in LOS.  It has also told me that I need an exit plan for when the inevitable happens. 

RIP, but no longer suffering.  So sad when the pharmacological tools are available, but the doctors simply refuse to utilize them.  Ignorance of palliative care is one hell of a poor excuse for a medical doctor.   These people should be ashamed, especially if they profess to be Buddhist.  Even my teacher, and forest monk of of 43 years, put's it simply: "Take the morphine!  There is no reason for needless suffering."  But then again, he is not Thai.

[connda]

On 8/29/2017 at 1:49 PM, Sheryl said:

Singapore has well developed hospice services both in-patient and in the home.

 

But if you are going to travel away from home could just as well be in a hospital in Thailand. End-of-life care in the better private hospitals, if you have a palliative care specialist as your primary doctor, are OK. The gap is for hospice type care in the home.

I'm going to ask for a big favor, because I understand the time and research that may be involved.

Can you together with others who are our Subject Matter Experts for expat healthcare here in Thailand, attempt to put together a list of palliative care specialists who can also be the primary care physician for those seeking to plan for end of life care here in Thailand.  

Living in the Chiang Mai area, I've looked at the list of pinned physicians, and there are no "palliative care specialist."  And I see no other types of listing like that in the Healthcare forum.  Perhaps I'm simply missing it.

Adding palliative care specialists to the lists of physicians available would be an immense act of compassion by the individuals who put such a list together.  Obviously (and perhaps selfishly) the Chiang Mai list of doctors is definitely where I would like to see palliative care specialists for the Chiang Mai region listed.  

Many of us who plan to live here to the end of our days would be in your debt.  

Thanks!

[Sheryl]

Will do. Give me a few days.

[Sheryl]

RIP, but no longer suffering.  So sad when the pharmacological tools are available, but the doctors simply refuse to utilize them.  Ignorance of palliative care is one hell of a poor excuse for a medical doctor.   These people should be ashamed, especially if they profess to be Buddhist.  Even my teacher, and forest monk of of 43 years, put's it simply: "Take the morphine!  There is no reason for needless suffering."  But then again, he is not Thai.

I think we should be careful about making what may be wrong assumptions.

It is quite likely that they did prescribe painkillers for this man. All we know is that towards the very end, despite them he had pain, the family brought him back to the hospital at that point and the doctors evidentally assessed that the intensified pain was due to pressure from ascites and that the best means of alleviating it would be to do a paracentisis (drainage of the ascitic fluid), which they did and which apparently did give him significant relief.

We don't have any reason to think that doctors were told the pain meds were insufficient and refused to increase them. We also don't have reason to think that he was not already on at least some amount of oral morphine.

[al007]

Registering with British Embassy on death and release of body as applicable to those  English people with legally registered marriages, and thus Thai next of Kin

 

I had a long conversation with my Embassy The British Embassy after a chain of emails,  Yesterday

 

The information I obtained is different from some on Thai Visa

 

The told me the following

 

They do not have a register of British Nationals, living in Thailand, who have voluntarily registered and further it is not possible to register with them

 

They advised me for my body to be released from a hospital, on death; all my Thai wife has to do is produce copy of marriage certificate,( there is no requirement for the British embassy to be involved) she is then free to arrange the funeral or donation of the body according to the deceased wishes, The UK Embassy said their approval is not required, in any way so far as they are aware

 

They also said a will is a strong suggestion, I already have one in both Thai and English

 

They did also say in the event of any problem call the Embassy and help to resolve matters would be immediately forthcoming

 

I also have a file on what to do on death, with separate pages for each item, like will, page for each bank account, page for pension fund, page for stockbrokers, summary page of assets, page of those to be contacted, etc etc

[al007]

Those reading this thread should also maybe look at thread home nursing care

 

This is all becoming more of a reality for me, unfortunately, but the good news is I have been preparing myself and options for nearly a year, and in that time learnt a great deal

 

Life is a bitch and then you die, as some of the negative brigade say but not my philosophy, yes living is terminal, and my life has been and by the Grace of God  still is shall we say colorful, the question is do I have time left to complete my life story, some will be happy if I do not!!

 

Interesting when I refer to God my School Motto was God Grant Grace, until today I never appreciated these words so much

 

DO YOUR FORWARD PLANNING

 

God Bless remember our English humor, a special kind not understood by all

[al007]

As part of my forward planning, and philosophy plan for the worst and hope for the best, I am in the process of drafting a living will, I have also moved substantial assets to my wife with the exception of the car that will be done prior to surgery, and yes my wife also has a will leaving everything to me, needless to say I trust my wife and I have had some very bad ones, so do not do this lightly

 

When I go to surgery I will own nothing

 

 

 

I would appreciate input, as part of my career I was well trained legally and am not worried about the drafting side

 

Living Will

 

This deed dated ……………………………….

 

I *************, UK Passport holder **********, being of sound mind and aware that I have both colorectal and prostate cancer, with surgery scheduled soon, declare the following

1 If during surgery my heart stops only three attempts should be made to resuscitate it

2 I understand and agree when in surgery life support systems may be temporarily used to facilitate surgery

2 I do not wish when I come out from surgery  to be on a life support machine, for the avoidance of doubt IV drips are acceptable I understand the consequences of this

3 If at any other time before or after surgery, my heart stops I do not wish to be resuscitated, and do not wish to be kept alive on a  life support machine

4 I wish my body and organs be donated either for transplant or for the benefit of medical science

 

Signed by ***********

 

Witnessed and agreed by Next of Kin

 

Witnessed by lawyer

 

 

I asked my prospective surgeon if he would have any problem and he agreed he would respect my wishes and asked me to document it

[faraday]

I wish you peace of mind in this difficult time.

[NancyL]

1 hour ago, al007 said:

As part of my forward planning, and philosophy plan for the worst and hope for the best, I am in the process of drafting a living will, I have also moved substantial assets to my wife with the exception of the car that will be done prior to surgery, and yes my wife also has a will leaving everything to me, needless to say I trust my wife and I have had some very bad ones, so do not do this lightly

 

When I go to surgery I will own nothing

 

 

 

I would appreciate input, as part of my career I was well trained legally and am not worried about the drafting side

 

Living Will

 

This deed dated ……………………………….

 

I *************, UK Passport holder **********, being of sound mind and aware that I have both colorectal and prostate cancer, with surgery scheduled soon, declare the following

1 If during surgery my heart stops only three attempts should be made to resuscitate it

2 I understand and agree when in surgery life support systems may be temporarily used to facilitate surgery

2 I do not wish when I come out from surgery  to be on a life support machine, for the avoidance of doubt IV drips are acceptable I understand the consequences of this

3 If at any other time before or after surgery, my heart stops I do not wish to be resuscitated, and do not wish to be kept alive on a  life support machine

4 I wish my body and organs be donated either for transplant or for the benefit of medical science

 

Signed by ***********

 

Witnessed and agreed by Next of Kin

 

Witnessed by lawyer

 

 

I asked my prospective surgeon if he would have any problem and he agreed he would respect my wishes and asked me to document it

• What do you consider a "life support machine"?  A respirator, supplemental oxygen supplied through a nasal cannula or face mask, a feeding tube, a kidney dialysis machine?  All these devices can be used temporarily for people who are very ill but later recover nicely.

[al007]

26 minutes ago, faraday said:

I wish you peace of mind in this difficult time.

Kind thoughts, and appreciated

 

Actually my medical problems are I believe a challenge and over a lifetime I have overcome many

 

Sometimes the challenges of not upsetting people , and not breaking the rules of TVF can present me with bigger problems and challenges !!!! and I promise I have no wish to provoke or upset, but do not accept fools easily, and sometimes when I see what I believe to be incorrect statements open my mouth, when I would be better advised to walk away, but that is also me

 

 

4 minutes ago, NancyL said:

• What do you consider a "life support machine"?  A respirator, supplemental oxygen supplied through a nasal cannula or face mask, a feeding tube, a kidney dialysis machine?  All these devices can be used temporarily for people who are very ill but later recover nicely.

Thank you NancyL, your comments are exactly what I am looking for, and over the next week I will refine the document, I will also of course discuss it with the surgeon to ensure so far as he is concerned it is workable

 

I have already said all IV is acceptable, for me kidney dialysis machine no, a respirator probably no, first of all I have to cover the operating theatre then recovery, and give greater powers to my wife in the event I am unable to make the decision mainly in recovery, and my principal probably goes along the lines if I can not make that decision then maybe do not do it, oxygen is OK

 

With careful planning and thinking I will find the correct wording

 

I am 72+ have had an exceedingly good life, and been wonderfully cared for over the last ten yrs here, I am self insured, I do not want to die in pain, I accept living is terminal, I would also grab with great enthusiasm another ten years, retired 20 plus yrs ago, at the moment my wife; if sensible will be well provided for, and for the sake of a small extention of being here I do not wish to blow her well earnt inheritance

 

In life there come a time on everything when one must stop throwing more good money into that black hole

 

I still make enough money each year on the stockmarkets to live well, I have strong financial and legal background, so this is relatively easy and enjoyable

 

I do not have the right to say here stop if I wish to end my life, so I have to take even greater care to see it is not overextended by well wishing doctors, at unacceptable cost to me, I also need to do it when of clear thinking and not under major sedation, as my wishes then could be ignored on the basis at that time I was not of sound mind

 

All a question of balance

[Sheryl]

Many Thai hospitals have their own forms for advance directives and may not accept one not in that format. Suggest asking the hospital. (As it is a government hospital, will need some perserverance and patience but should eventually find someone who knows what you refer to).

[al007]

4 hours ago, Sheryl said:

Many Thai hospitals have their own forms for advance directives and may not accept one not in that format. Suggest asking the hospital. (As it is a government hospital, will need some perserverance and patience but should eventually find someone who knows what you refer to).

Appreciated

 

The surgeon concerned agreed he would follow, my written wishes, but you are correct we must have the hospital agreement as well, just under three weeks prior to operation I have a day of pre op checks, by this stage my document will be final, and yes I expect the procedure to get it onto my file will be time consuming, and maybe I should have it in thai as well as english

 

After all this is Thailand

[NancyL]

You may wish to look at this Advance Directive, developed by Lanna Care Net and Cancer Connect with input from several hospitals and Consulates, that has been used very successfully in Chiang Mai. http://www.lannacarenet.org/wp-content/uploads/2015/02/LCN-Advance-Directive-Word-2-11-February-2015-1.pdf

 

A key point of my previous post is that you can't anticipate every possible hypothetical upcoming situation and there are conditions where it makes much sense  to restart someone's heart, put them on a ventilator for a few days, use a feeding tube for a couple weeks, etc if it is anticipated that the person is going to recover.  That's why it's important to select a good "Health Care Representative" to act on your behalf, rather than trying to micromanage your care in advance.  

 

An HCR doesn't necessarily have to be a "friend", but rather someone whose judgement you respect.  When you recruit someone for this job, you should have a series of meetings with them and discuss what quality of life issues are important to you.  Some people would say they wouldn't want to live if they could never walk again and others would say they're OK with being bedridden, but don't want to be a financial burden.  Everyone has different criteria and it's important your HCR knows what's important to you.  

 

Your doctor cannot be your HCR, incidentally.

[al007]

22 hours ago, NancyL said:

You may wish to look at this Advance Directive, developed by Lanna Care Net and Cancer Connect with input from several hospitals and Consulates, that has been used very successfully in Chiang Mai. http://www.lannacarenet.org/wp-content/uploads/2015/02/LCN-Advance-Directive-Word-2-11-February-2015-1.pdf

 

 

An excellent link and very helpful

Appreciated

[al007]

I have been thinking and looking at this question of a Living Will/Advance Directive, and adopted many points from Lannacare document above, thank you NancyL

 

Different jurisdictions have different laws and in some when you become mentally not there, that living will can cease, hence the appointment of a Health Care representative

 

I plan for the worst and hope for the best, the surgery does not scare me, the colostomy bag and recovery together with pain does worry me a lot

 

In the wish to assist others, I am putting my nearly final version below, I AM NOT A LAWYER, and not fully cognisant of the laws of Thailand and would recommend maybe before following me, you take legal advice, which I am not doing as I am reasonably happy it will be satisfactory.I will get a friendly policeman to be a witness

 

I am also aware that I need to agree in advance with the hospital, however in the event they did not agree I would still do it as it could serve later if I were on a life support machine

 

 

Advance Directive
This deed dated ……………………………….
I xxxxxxxxxxxxxx, born xth April 1xxx, UK Passport holder xxxxxxxxxxx, being of sound mind and aware that I have both colorectal and prostate cancer, with surgery scheduled soon, to stay in effect until revoked, declare the following
1 If during surgery my heart stops only one attempt should be made to resuscitate it, in the event, at any time, it stops a second time no attempt to resuscitate should be made
2 I understand and agree when in surgery life support systems may be temporarily used to facilitate surgery
3 I do not wish when I come out from surgery  to be on a life support machine, for the avoidance of doubt intravenous drips and oxygen are acceptable I understand the consequences of this
4 I have very low pain thresholds and wish to be given whatever painkillers necessary  by what ever means, to suppress pain even at the risk of becoming addicted
5 If at any other time before or after surgery, my heart stops I do not wish to be resuscitated, in any way whatsoever, and do not wish to be kept alive on a  life support machine
6 If I become unconscious I should be allowed to die peacefully
7 I wish my body and organs be donated either for transplant or for the benefit of medical science
8 in the event of my death my legal wife and next of kin Supaporn Bayne has the right to make all decisions

For the avoidance of doubt I may be given oxygen, any drugs considered beneficial or to kill pain, anything through either injection or intravenous device, I do not want life support machines, or resuscitators or kidney dialysis, or any machine whatsoever to prolong life unnecessarily

APPOINTMENT OF HEALTH CARE REPRESENTATIVE 
I appoint my wife xxxxxxxxxxxxxx as my health care representative. My representative’s Telephone number: 08901 78913
I authorize my representative to direct my health care if I cannot and if my original wishes are unclear, to make whatsoever decisions are necessary
1. Life Support. 
Life support refers to any mechanical/electronic means for maintaining life, by refusing life support,I understand I may die, I still expect to get routine measures to keep me clean, comfortable and pain free
My  Health Care Representative may decide about life support for me, if my wishes above are not clear
2. Tube Feeding.
One sort of life support is food and water supplied artificially by a medical procedure, known as tube feeding.

My Health Care Representative may decide about tube feeding for me.


HEALTH CARE INSTRUCTIONS 
I wish my Health Care Representative to make all decisions where possible

Life support and tube feeding are defined above.

If I refuse tube feeding,  I understand that  malnutrition, dehydration and death will probably result.

If I am close to death  or permanently unconscious , or have a progressive illness that will be fatal ,or I am consistently and permanently unable to communicate by any means, swallow food and water safely, care for myself and recognize my family and other people, and it is unlikely that my condition will  improve and life support would only postpone that moment of my death: 

I do not want tube feeding, and I want no life support. 
General Instruction. 
I do not want my life to be prolonged by life support. I also do not want tube feeding as life support. I want my doctors to allow me to die naturally if  I am in any of the medical conditions listed above
I do not want anything that would cause me to suffer undue pain, my pain threshold is low

I have no other living will, Advance Directive or similar document in existence

DIRECTIVE FOR MY BODY AFTER DEATH 
 My funeral arrangements  to be according to the wishes of my wife and costs to be kept reasonable.
I wish if possible for my body and organs to be donated to science  or others and the remains to be disposed of in accordance with the policies of the recipient institution. 

Signed………………………………..………….. Dated……………………

xxxxxxxxxxxxxxxxxxxx

DECLARATION OF WITNESSES 
We declare that the person signing this Advance Directive:

(a) Is personally known to us or has provided proof of identity;

(b) Signed or acknowledged that person’s signature on the Advance Directive in our presence;

(c) Appears to be of sound mind and not under duress, or undue influence;

(d) Has not appointed either of us as health care representative or alternative representative; and

Witnessed By:

…………………………………………………………Date………………


Printed Name of Witness……………………………………..


Signature of Witness/Date……………………………Date……………..


Printed Name of Witness………………………………………. 

ACCEPTANCE BY HEALTH CARE REPRESENTATIVE 
I accept this appointment and agree to serve as health care representative. I understand I must act consistently with the desires of the person I represent, as expressed in this Advance Directive or otherwise made known to me. If I do not know the desires of the person I represent, I have a duty to act in what I believe in good faith to be that person’s best interest. I understand that this document allows me to decide about that person’s health care only, while that person cannot do so. I understand that the person who appointed me may revoke this appointment.

Signature of Health Care Representative……………………………………..

Dated…………………………

xxxxxxxxxxxxxxxxxxxx

 

 

Receipt acknowledged by xxxxxxxxxxxx Hospital

 

[NancyL]

Al, be certain your wife is willing to accept the responsibility to act as your health care representative, which means she will need to have a signed original of your Advance Directive with her at all times when you are in hospital in critical condition and be prepared to show it to doctors and nurses and act as your advocate, sometimes forcefully act as your advocate if she sees them starting to undertake measures that are against your wishes.  

 

You cannot assume that the hospital will be willing " acknowledge receipt" or keep this document in your chart or that every health care professional who treats you will read it.

[al007]

3 hours ago, NancyL said:

Al, be certain your wife is willing to accept the responsibility to act as your health care representative, which means she will need to have a signed original of your Advance Directive with her at all times when you are in hospital in critical condition and be prepared to show it to doctors and nurses and act as your advocate, sometimes forcefully act as your advocate if she sees them starting to undertake measures that are against your wishes.  

 

You cannot assume that the hospital will be willing " acknowledge receipt" or keep this document in your chart or that every health care professional who treats you will read it. ( I note and fully agree, very relevant)

Again  very helpful thank you

 

Lets hope this will not be needed

 

I am very lucky, I have a close relationship with my wife and discuss and share everything with her

 

All our assets are now in her sole name and under her control, and no probate will be required in any of the four countries where I have/had assets

 

(there are those on TVF who may think I am mad, but after 45 yrs marriage in total and four wives including a very evil one I trust her, and her will also leaves everything to me)

 

The surgeon has said he will respect my wishes, I will not ask him to sign, I have to trust him as well, he is rather important, I need his goodwill ! I will however request he reads the document 

 

I agree it is unlikely the hospital will sign and acknowledge but at least lets try, when there for pre op tests we also need to see if the hospital might accept my body, and if so complete their forms

 

At Chulalongkorn, I am booked for a private room around 4000/5000 bhatt, has the advantage my wife can stay in the room 24/7as well in a ward room wife only allowed at normal visiting hours, hopefully hospital will be about ten days , with another week at hotel close by just in case, as recommended by surgeon

 

My wife is fully aware and agrees my wishes, she amazed me recently when arguing with Honda on warranty she talked lawyers, very not Thai but she has learnt from me, and if necessary I know she will be very strong, and do her very best to see our joint wishes are carried out

 

I propose to have three originals and copies, one original will stay at home

 

I am also adding to the on death bit , a statement to the effect UK embassy approval is not required to release  the body to next of kin with a phone number the Embassy gave me when enquiring on this topic, again just in case

[impulse]

10 minutes ago, al007 said:

(there are those on TVF who may think I am mad, but after 45 yrs marriage in total and four wives including a very evil one I trust her, and her will also leaves everything to me)

 

Screw 'em.  It's your life, not theirs. 

 

On a serious note, I'm assuming you've had a Thai translation done (and checked carefully- with a legal eye toward the framework of the Thai legal system)?  Or are planning to have one when the time comes and you have the details finalized?

 

Best of luck to you!

[al007]

2 minutes ago, impulse said:

On a serious note, I'm assuming you've had a Thai translation done (and checked carefully- with a legal eye toward the framework of the Thai legal system)?  Or are planning to have one when the time comes and you have the details finalized?

 

Best of luck to you!

 

I choose to take risks, but consciously and the question of translation i have thought about, at Chulalongkorn where I have already spent many weeks the level of English is good, at the moment I am planning on not doing it, however I keep an open mind

 

I would also be worried on translation something was done incorrectly, maybe better not to do, I know if I went to court the document would need to be translated, but cross that bridge if we ever got there, and I am confident we will not

 

Lawyers again maybe not, when I successfully negotiated a malpractice settlement with an unnamed hospital without lawyers,  I went to a lawyer, for drafting, I wound up preparing the legal document doing the work and still paid him, I was paid a substantial sum which I received.

 

I live in Issan and trust worthy good, english speaking lawyers are hard to find, I had a lawyer for the Usufruct and after a couple of years questioned whether or not it was properly registered, he got mad at me and threatened ME with deformation case, I was grateful because it meant I cut all ties with him

 

Your advice is good and sound, my safeguard I believe to be my wife, and HIM upstairs

 

Appreciated

[impulse]

3 hours ago, al007 said:

I choose to take risks, but consciously and the question of translation i have thought about, at Chulalongkorn where I have already spent many weeks the level of English is good, at the moment I am planning on not doing it, however I keep an open mind

 

I would also be worried on translation something was done incorrectly, maybe better not to do, I know if I went to court the document would need to be translated, but cross that bridge if we ever got there, and I am confident we will not

 

Probably 99% chance you're good with the English.  But I'd still allow for the possibility that some HiSo on duty exactly in your time of need will either not understand English, not be interested in even reading an English document, or may even be afraid of the legal (and monetary) consequences of pulling the plug based on an English document, regardless of any previous discussions you may have had with someone else on staff.

 

I'm not holding myself out as an expert.  The truth is I don't know.  Just food for thought and possible discussion with someone who does know.  Sounds like you've already got it covered.

 

[al007]

9 minutes ago, impulse said:

 

Probably 99% chance you're good with the English.  But I'd still allow for the possibility that some HiSo on duty exactly in your time of need will either not understand English, not be interested in even reading an English document, or may even be afraid of the legal (and monetary) consequences of pulling the plug based on an English document, regardless of any previous discussions you may have had with someone else on staff.

 

I'm not holding myself out as an expert.  The truth is I don't know.  Just food for thought and possible discussion with someone who does know.  Sounds like you've already got it covered.

 

Your time in replying  and giving input is appreciated

 

I am really hoping it will all be merely an academic exercise, it certainly stops me thinking about the consequences, and worrying about having done nothing

 

It has already been suggested I micro manage, incidentally I only do when essential

 

My wife has full power will be there 24/7 unless at 7/11  ! !, I have now added a clause giving her full discretion to change anything she so wishes

 

It is actually not about unplugging more about plugging in, I am pretty laid back on it all

 

I am also very aware like many things in Thailand it could be yet another challenge

 

I will be discussing all this with the Hospital at least two weeks prior to the op, I am pretty sure I will not be the first one to request something similar to this, and if the hospital were to reject it all so be it, at least my wife has a document giving her power

 

It is difficult to get views from those who have been successful in using this, I do not know how to contact them  ! !

 

Keep smiling and stay happy

 

I can only do so much

[al007]

Well today I filled in a form at Chulalongkorn, and now have a donor card for my body and its organs, easy easy

 

I also got after a fight not with the doctor who slowly read my lining will but agreed to have it attached to my file, the nurse later tried to stop this but after a fight when i pointed out the doctor was higher in the chain than she agreed

 

ANY ONE WHO WANTS A COPY OF MY LIVING WILL PM AND I WILL SEND A COPY

[al007]

Advance Directive/  Living Will 

 

I was very pleasantly surprised by the reaction to my Advance Directive/ living will, it was discussed with three surgeons and the two anaesthetics, at Chulalongkorn Hospital,  they were all happy to comply, and said it was very clearly written,  and they appreciated having it; as it removed from them difficult decisions, I never considered this aspect when drafting it

 

They were also aware of my wish to donate my body to the hospital, and had a copy of that also on file

 

I did not push my luck and ask them to sign or  acknowledge it

 

My wife had an original with her at all times just in case

 

Post operation I had morphine on demand, however paracetamol, that the doctor agreed I could take on demand was more difficult, the nurses were loathed to let me have it, so I used my own emergency supply and overcame that one

 

I am not sure that the morphine did a lot I was given 3 mg per hour, the younger doctors were not averse to prescribing it

 

I suffered pain from the eleven hours of surgery, and also hip and joint pain as a result of having been strapped into a position with my legs apart and in the air, for a very long time, I was very bruised, they were also worried about thrombosis, and kept me on drugs to reduce the risk here for a week

[al007]

On 9/27/2017 at 12:15 PM, impulse said:

On a serious note, I'm assuming you've had a Thai translation done (and checked carefully- with a legal eye toward the framework of the Thai legal system)?  Or are planning to have one when the time comes and you have the details finalized?

 

On my last experience it was all in English and worked well and was understood by all the doctors

 

I would worry the translation might say the wrong thing, bearing in mind this is Thailand