Other than his family, Bob Hellriegel’s great passions were sailing and playing the mandolin, a gift from his four children on his 60th birthday.
He felt great peace on the water and loved music, especially opera and bluegrass. Both allowed him to turn off his brain and steer his soul away from work.
If there were one regret he had his whole life, it was this: his four children didn’t share his love for sailing.
They might not still, but they’ll grant their father a final wish. In April, they and their mother, Jan Hellriegel, will take a biodegradable urn bearing a third of Bob’s ashes board a sailboat, set sail on Lake Lanier, and spread his ashes in the water.
“We want to honor his decisions,” Jan Hellriegel said recently at her home in Marietta.
Two other urns will be taken on final trips in the Caribbean and the Gulf of Mexico.
Each trip will be a celebration of Bob’s life, void of the guilt that often comes after a loved one suffers through a terminal illness while their wishes for medical decisions are unknown.
Days before his death from cancer last November, Jan said her husband, a project manager who was all about time lines, laid out his wishes for care and documented them in a POLST or Physician Orders for Life-Sustaining Treatment.
“It was a way for him to be at peace and for us to be peace,” his widow said.
For a growing number of terminally ill patients, the POLST has become part of the care offered at hospitals and health care facilities.
The WellStar hospital system is at the forefront of this movement and is working to expand the use of the POLSTs in its long-term care, assisted living and hospice facilities.
“We’re working toward all WellStar patients who have a chronic disease or who are at the end of their life having a POLST,” said Dr. Richard W. Cohen, director of ethics and chairman of the Georgia POLST Collaborative.
Cohen, an orthopedic surgeon, said the document frees family members of the burden of making difficult decisions under duress.
“Five years ago WellStar established the palliative care program to assist the health care team to have these discussions proactively rather than reactively,” Cohen said.
The POLST gave the hospital a tool to help patients summarize their wishes.
“The focus of all of this is to ensure that every patient receives the care that they want without prejudice,” Cohen said. “So if you want everything to be done to sustain your life, that’s perfectly fine. It’s not meant for everybody – really patients with chronic diseases who are probably at the end of their lives.”
Introduced in Georgia about seven years ago, various hospitals used POLSTs but there was no state-coordinated effort. That changed in July, when the Georgia Department of Public Health adopted the POLST for use at all hospitals.
“So now the state has a single document that not only expresses a patients’ wishes, it can travel with them wherever they go in the form of a doctor’s order, which means your wishes will be honored no matter where you are,” Cohen said.
As a result, Cohen has been able to bring together a collaborative of more than 20 organizations that are working to promote the use of POLSTs. A seminar will be held May 6.
When should families start this conversation?
“Ideally people should have these discussions when they come to a point in their lives of responsibility,” Cohen said. “If you don’t meet the ideal, you should seriously do it when you develop a chronic disease.”
Patients need to do two things he said. Talk with your family so they understand your wishes, and provide a copy of the document to your primary doctor.
The Hellriegels drew up living wills in 2002 but hadn’t heard of a POLST.
Then in March 2011, after a routine physical, Bob was diagnosed with stage 4 prostate cancer.
In following months, he was in and out of the hospital - and surgery.
“He used to say, particularly at the end, I’ve reached the end of my slippery slope,” Jan recalled.
Dr. Jonathan Hsu, a hospice and palliative care physician, asked Jan to bring the couple’s will and casually mentioned a book about ways patients could lay out, step by step, their final health care plan. He knew it was time to have the difficult talk with family.
Hsu said patients at the end of their lives often endure burdensome treatment.
“Patients undergo needless tests, painful procedures when the outcome may remain the same,” he said. “Instead of prolonging quality of life, you may inadvertently prolong suffering.”
By the time Dr. Cohen came knocking with the POLST, Bob had spoken to family and friends about his final health care plan.
“He gave them to whomever came into his room,” Jan said. “We all got one. His friends. His 91-year-old mother.”
On October 27, Bob took Communion and on Oct. 30 went into hospice care. Six days later, he died.
Instead of a funeral, he wanted a celebration of his life, Jan said. After the trip to Lake Lanier, the remaining two urns of ashes will make similar trips, one to the Caribbean, the other on his coffee buddies’ bi-annual fishing trip to Destin.
“It will be the only time we’ll all be together on a boat,” she said.
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