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I think I want to eat healthy.

0id

I want to completely cut out fast food. I want to have more set meals and I just want to eat healthy food. Okay.

0id

I think I at least needs to go to the grocery. Okay.

0id

Is that something that you haven't been doing?

1irq

No, not lately. I've just been grabbing food at work, or going through fast food on the way home. Okay.

0id

Like, I just haven't had the energy or desire to go and I've also been been working a lot trying to save up money for the baby. Finding the time might be hard. Okay,

0id

I used to go every week on Sunday. And I used to already have a list in mind before I went,

0id

That would probably make it more likely for me to go. I don't have to be at work until the afternoon that day. So I can maybe go asleep and a little bit maybe at like 10 o'clock on Sunday.

0id

Well, lately when I haven't felt like doing things that I really need to do, I'll give myself a reward. And I know that there's this great bakery on the way. So if I tell myself, if I go to the grocery, then I can stop by the bakery on the way home, then I may be more likely to go.

0id

Hello stone,

2gt

yes.

2gt

Hi, I'm PJ Daniels. Sorry, let me wash my hands.

3gc

Call me, Dorothy.

3gc

Oh, thank you. That's the next thing I was going to ask you. So Dorothy, the nurse mentioned to me that you wanted to talk about your care is but what's going on?

1irq

Five days ago, I was admitted to emergency. And they treated me by putting this tube down my throat. And I tried to, to tell them and gesture at them that I don't want this tube down my throat. And I just hope that never happens again.

0id

Okay. No, I totally understand that. I mean, that is quite a scary thing to go through. And I think we do need to talk about this more, and I'm glad that you've asked it. Talk to me about this. So I had a little bit of a look through your charts. I think I understand why they did it. But did anybody explain it to you?

4crq

Well, not really. And because I was gasping for air and in the state I was, but I'll tell you what, I'm really worried that this won't happen to me again. I don't want that to be anymore. I'm, I'm okay to to pass this.

6cd

Absolutely. And you know what? There's no right answer when it comes to deciding on things that are aggressive, like the two, we really want to know what the patient values in terms of, you know, things that are that invasive, and so absolutely will respect whatever it is that you want. But I do need to find out a little bit more about you in terms of what is your understanding of what brought you into hospital.

1irq

Well, I have congested Part failure. And I guess there was water in my lungs and stopping me from breathing properly. So I was living in my soul, the ambulance brought me in to the emergency. So they that was how they were treating me.

0id

So you pretty much showed up to emergency. And very quickly they put that tube down.

4crq

That's correct.

6cd

Did anybody ask you if you were okay with that?

4crq

Well, I tried to gesture to them that I don't want the tube but

6cd

they didn't quite pick up on that.

4crq

I guess not. And, you know, I've had that three times already. I don't want to go through with

6cd

the two you've had.

4crq

Yes. I don't want it anymore.

6cd

Okay. And so so you have congestive heart failure, and it sounds like you've got a breathing problem. Yes. And do you know why they would have put the tube down. Do you know what they were trying to do?

11orq

I guess because I was short of air. I had a hard time breathing, right? So they tried to, like, I'm going to use the word save me.

10od

Right. So it sounds like you understand that. I mean, usually we only put a tube in. If that was the only thing we could do to save you. Most of the time of congestive heart failure. We'll give some medications. Have you heard of lasix? Or furosemide? No, okay. It's a medication will often give if someone is in heart failure, but if someone is really sick, and then we don't think we have time to give it that's the time we would think of a breathing tube. haven't had a chance to look through the chart, but it would suggest to me you were pretty close to dying when you came in.

11orq

I I guess so. But I'm okay with dying. Okay. You know, like I says, I've lived a good life and if it If the good Lord says that it's my time, I'm okay with that. And you wouldn't put it to

10od

No, my know already what I'm hearing from you. Exactly. I'm just gonna say exactly what you've said, sounds like you've lived a good life. You've been through this a few times, you know exactly what it involves. And if I could paraphrase to you quality of life is more important than quantity at this stage. Is that correct?

4crq

That is correct. And, but you know, what, doctor? How can I be assured that my wishes are respected, so I don't get this tube down?

6cd

That's an excellent question. So first, I did want to answer your previous question, based on what we're talking about. Absolutely. I agree with you that it is your wish, and we will respect that wish that we're not going to put a breathing tube down again. And then of course, your second question, which is great, as well as how do we make sure this doesn't happen? So what I'm going to do after our conversation, and I do have a few more questions, To ask you but after conversation, I write a note documenting what we talked about that we talked about the breathing too. And your reasons for why you don't want it, which of course makes sense to me. And then what I do is I document a short form called goals of care. And I just so it's a really easy way for everyone to look at the form and in two seconds, I know exactly what you want, we will give you a copy of that to take home. But I find that's not usually enough. What we also do, what I do is I tend to when you leave hospital, dictate a note to your family doctor. And that notes actually available online for anyone who might see you in any emergency department in Alberta. And in that note will very clearly state you and I have this conversation and you really didn't want the breathing to so I reassure you, we'll do everything we can to make sure people understand you don't want that to Okay.

11orq

All Thank you. I'm I was so concerned about that and yes, I I think I will rest now because like I say, that was a horrendous experience. And he says it won't happen again.

10od

Okay. I do want to ask you just a few other questions related to this. Go ahead. And the first question might sound a little off putting, but I sort of have to ask it anytime someone is changing the kind of therapy they want. We do have to ask, how was your mood? How are you feeling?

1irq

I'm I'm feeling fine. My mood is fine. I have no no problems.

0id

Okay, excellent. And how are you feeling overall about life before you came into hospital? Like when you're healthy as healthy as you can be? Say a few weeks ago?

1irq

I think I am enjoying life. Okay. Yes, I am enjoying life to the to the best I can.

0id

Okay, great. Yeah. And then other related questions, we did talk about the two that we wouldn't put it in. But again, we want to make sure we know everything that you might want or not want. Okay? So if we had to give you medications to get your breathing better, is that something you'd be willing to have?

4crq

Okay. And then usually along the lines with the intubation when people don't want the intubation, we often also want to know, if a nurse were to walk into the room and find just by bad luck, you would pass away or if someone just found you at home, who had passed away. Would you ever want people pushing on your chest and giving you shocks trying to bring you back to life?

1irq

No, no, no, I like I said, the good Lord knows when it's my time.

0id

No, and that'll make sense to me with no breathing.

4crq

Yes, and I have no problems with that.

6cd

There are some other things we can do. That's not a breathing tube, but they're a little aggressive. And one is have you ever heard of bipap?

5yq

I don't think so.

9on

It's a mass that really pushes air into you. It's a little uncomfortable, but nothing as bad as a breathing tube. Maybe hard to answer this question, because you don't know what that is. But to have any thoughts on that, if you were really sick if we were to try just a mask, and we would do it just as long as you were okay with it and comfortable at the time,

0id

would it be for a long time?

1irq

Now, usually, most times with bipap? It's only about two to six hours for most patients.

0id

Yeah, that would be okay with me. Okay. And if

7ack

we had to put large IVs and lines into your wrist and stuff, and take you to the intensive care unit. Again, we wouldn't do breathing too, but this is just to watch you closely.

3gc

Yeah, I would be okay with that. Yes, yes. It doesn't sound invasive to me.

3gc

Okay.

7ack

No, I just needed to be reassured that that it won't happen again. And and yeah, I'm, I know that on my chart. It's there. Yes, yes. And that's all I need to hear because I was concerned. Okay.

10od

okay. So if I change my mind, I can I will talk to you.

8op

Absolutely.

7ack

I don't think I'll change.

3gc

I don't think you will either. But it's just nice to see that you're aware of that. Okay. Um, honestly, I mean, there's some other questions. I tend to ask people when I don't know them. Well, just kind of routine stuff. Okay. And maybe we'll just quickly go through it go your medical history is the heart failure Anything else?

1irq

Um, that's it. I'm beginning with an ass but I can't remember what it is.

0id

Okay, that's okay. We can usually we have it written down. Yeah, your medications. I think I saw you're on aspirin and two jocks and I think two others. Do you happen to know or have them written down?

1irq

You don't want I always carry this paper with me because I can't remember the name. So okay.

0id

Oh, so you are on the water pill? The furosemide. Okay,

5yq

yes.

7ack

And. Okay, great. Yeah. Um, any allergies?

5yq

No.

9on

Okay. And I won't ask but anything that runs in your family, given your age, they told me you're 70 Is that correct?

5yq

That is correct.

7ack

Yes. And I do have to ask the following Questions completely unrelated to what we're talking about. That's okay. Do you smoke at all?

1irq

No, I don't

0id

drink any alcohol.

1irq

No, no.

0id

Okay. And this will be sound crazy, but I have to ask any street drugs, illegal drugs, anything like that?

1irq

No, I never had the opportunity

0id

to test any over the counter herbals In addition to these.

4crq

No, I don't take any of those.

6cd

And where are you living right now.

1irq

I'm living in a convalescent home for the last six months. I used to live in my own home. And six months ago, I'm moved to a convalescent home.

0id

Okay. And how do you feel about that? That changed six months ago.

1irq

I would really prefer my own home. But just trouble with my breathing sometimes, right?

0id

So you feeling better about being in that place now? A new home

11orq

It's okay. Okay, I really have to adjust. Like I say, if I had my druthers, I'd go back but I guess I have to learn to adjust to this right. Okay.

10od

So I think I sort of have all the information I need to make sure that your wishes are respected. Just one last time. Anything else you want to talk about today?

5yq

Oh, you answered my question. I was so worried about this tube.

8op

Okay. All right. Well, it's very nice to meet you and Stone.

2gt

Thank you.

2gt

So I understand that you've come in because you're having a little difficulty in your relationship about that.

1irq

So, basically, it's been getting a little bit worse since we got married. We got married about a year and a half ago. And, you know, the the woman that I married, I thought we were both kind of independent people. And I thought that we would kind of go our separate ways or thing like we used to college, but it's kind of gotten to the point now where it's like, I just want my own personal space and I I don't want to be left alone sometimes.

0id

Alright, so you're looking for independence in your relationship. Now, how long have you been together? About a year?

1irq

total four or five years, married for a year and a half.

0id

And when Franklin Did you notice that? What you kind of think it was the problem like the independence, lack of independence?

1irq

I guess kind of once we got married after that, it seemed like, you know, we were spending all of our time together, which, you know, at first was great because we're newlyweds, you know, we love spending time together and everything, but I guess probably about, you know, six months to a year after we first got married, it's kind of, you know, progressed to the point where, you know, now it's just kind of becoming like a burden that whatever I do, she's always there with me. We're always spending every waking moment together and sometimes it's just nice to have My own personal space is freedom, you know.

0id

So you're looking for that freedom. Sarah, this kind of resonate with you?

5yq

Can you can you tell him that?

5yq

So Frank, what's it like to hear that?

11orq

It kind of Reminds me of how it used to be, you know, like, she said, we've been dating for four or five years and, you know, back then it It wasn't a problem, you know, she could go out and do her own thing I could go out and do my own thing to not have to worry about each other but now that we're spending every moment together, you know, it's just I'm always worried about her she's always worried about me and you know, when when I do get the chance to go you know, hang out with some friends or something like that. It always feels like, you know, I've pressure on me because I should be with her. She shouldn't be there with me, you know, and I feel like I'm doing the wrong thing by trying to be independent try to go do things by myself. I feel guilty. I do.

10od

So, Sarah, Do you sense that and, frankly, feels guilty about that?

5yq

You feel rejected.

0id

this a little bit after. So, like I said, probably the first six months to a year it was it was really good. But then, you know, reselling is kind of a burden. You know, just always spending time together and trying to make amends and try not to get into fights because we're always spending so much time together.

0id

So you mentioned that the six months to a year has been the same for you like was the beginning of the marriage, something different to what you have that

1irq

So for you a couple months after that initial phase. So around the same time you started experiencing this difficulty in the marriage

0id