Tuesday, February 24, 2015

Hard conversations and being mortal

While watching a movie recently, (“Still Mine”) a conversation occurs with a woman in her mid-eighties who asks her spouse, “Do you think much about dying?” He responds, “Probably not as much as I should”. She says, “When I was young, I looked at old people…and thought if you live long enough, you’ll probably have time to figure out dying. But I’m no closer now to the great mystery than when I was 10”. Her spouse answers, “You see that as a problem, do you?”, and she quips, “We’ll see soon enough”.

Ah, the problem I am constantly faced with! Whether aged or not, so many near-dying people are still waiting to make a plan. Still no closer now, in their eighties, to recognizing that the deep mystery of death is just around the corner, and they haven’t really talked about what they want, as they are dying- the where, what, how of it is not even considered. Where, if you ask most people, is in their home, what and how of it is usually wanting a quick and painless death, avoiding suffering as much as possible, with the ability to say goodbye, and I love you to family. Many have not completed an advanced directive or a POLST, and have hardly scratched the surface of a real conversation.

We are deluged with articles and reports about having “the conversation”, and the recent "Being Mortal" Frontline special highlighted, again, what those of us working in hospice and palliative care are experiencing almost daily. The conversations are difficult. They are fraught with emotions, awaiting the abyss of grief when patients and families realize truths of the disease progression. The spouse hears that it is time for hospice, and is overcome. Not a comfortable moment for the doctor, but she is able to quietly sit while the harsh truth sinks in. Yes, the patient has been dying, incrementally, but now in earnest. Time is of the essence for the patient and family. And the medical team must be human, not cloaked in the protection of white coats and emotional detachment. It is not the time to whitewash the conversation in vagueness or unrealistic expectations: honesty with compassion is needed. “When words are both true and kind, they can change our world” (Buddha).

We all were born with the disease of mortality. And yes, “there’s no natural moment to have these conversations except when a crisis comes, and that’s too late”(Gawande). But for a grandfather who is reaching the end of his life, it can be a defining moment to talk to his young grandson; that just as the animals in the farm die, the grass and trees in the field die, so in the web of life, we all are dying, and he will be dead, soon, too.

There are so many moments to grasp, if we are conscious of them, to sit quietly and share the experience of being mortal.

Amy Getter is a palliative care and hospice nurse who cares for patients with life limiting illnesses. She lives on the Oregon coast and is passionate about her family, being surrounded by natural beauty, and telling stories.http://hospicediary.com/

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