Tough Conversations

Solutions Through Compassionate Communication.

Palliative Care: Pros and Cons

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When my father was 93, riddled with cancer, chronically nauseated, and living on opioids he suffered a major heart attack. In the hospital, doctors determined his death was imminent but didn’t tell him. Dad denied his condition was serious. He was furious to be given a room on the heart ward instead of the ICU.

Dad had signed a DNR (do not resuscitate) and disclaimed extraordinary measures. But he changed his mind when push came to shove. He raged for two days until, at my request, a female resident physician sat beside Dad’s bed and gently told him the truth. Then he agreed to accept palliative (comfort) care. He needed to hear his time was short and he could control how it was spent.

Palliative care (with or without Hospice) can be received in a hospital, a nursing home, or the patient’s own home. Medical interventions are out; comfort and pain relief are in. Surprisingly, comfort care often extends the patient’s life beyond expectations, perhaps because it allows him to set his own priorities as the end approaches. He might continue to attend church, meet a new grandchild, participate in a daughter’s wedding, or celebrate a family holiday. [Read more…]

What Makes a Conversation “Tough”?

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It takes guts to start – and sometimes to stick with – a tough conversation. We’re afraid of triggering anger or hurt. Or being misunderstood. But some conversations are necessary.

Let’s say I’m wondering whether Mom and Dad have a will. And who’s the Executor? And who is getting what? Here’s the parade of horribles that might be going through my head:

My parents might think I want them to hurry up and die.

They might think I’m greedy.

They might think I’m trying to curry favor over my sister to get more than she does.

They might think I’m trying to trying to control what they do with their own money, as if it’s already mine.

They might think it’s none of my business. And say so!

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Relinquishment: Letting Go

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There’s no sugarcoating it: losses hurt. Whether it’s “aging out” of favorite activities, loss of meaningful work, or even the death of a person you loved, slogging through the pain and grief and anger of loss is hard!

But there’s another way.Relinquishment: Letting Go

Acceptance may come slowly and feel forced. We greet it with tight lips and a closed fist. We resonate with Ann Lamott’s, “Everything I ever let go of had claw marks on it.” Our fist is being pried open. We feel like victims.

Relinquishment is acceptance-plus. It’s an active, intentional attitude of letting go. We open our fist and freely offer whatever is being taken away. We may not be able to avoid our loss but we can control our response to it. We meet it with an open hand, an open heart, and a free spirit. [Read more…]

Death Terms and Euphemisms

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From time to time, Tough Conversations will present articles by guest bloggers on topics of interest to our readers. M. Jane Markley, an expert on advance care planning, wonders why it’s so hard to talk about death:
Death Terms and Euphemisms

Have you ever noticed just how difficult it is for people to say the word “death” or “died”? You mostly hear the terms when something horrific has happened like an earthquake or a bombing but in day to day life it is rare. This is part of our culture of death avoidance. Just take a look at the obituaries. If we don’t say it, perhaps it won’t or didn’t happen. If you listen carefully you will hear many other phrases or words used but rarely “death”. [Read more…]

Talking to Grief – Part 2

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“What can we do to help?” friends asked me as my husband lay dying and soon after he passed. At first I didn’t know how to answer.Talking to Grief - Part 2

I was still feeling my way through early-stage grief, from the inside out. At first I didn’t know what I needed, but others sometimes recognized a need and offered specific help. Or just showed up with it. Sometimes my head was clear enough to ask. Sometimes not.

I previously wrote about helpful things to say to a person going through a loss (Talking to Grief). But it’s not all about words. Support comes in words and actions.

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Talking to Grief

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by Carolyn Miller Parr

Talking to GriefWhat can you say to the parent of a 17-year-old son who dove into a wave this summer and came up paraplegic? Or your 53-year-old family member who suddenly discovers he is riddled with cancer? Or “Sarah,” a church friend, who will soon celebrate her 56th wedding anniversary, holding her husband’s hand and watching his slow but unstoppable surrender to dementia and death?

Recently I have felt surrounded by grief. It knocks at my own door and I see it everywhere. I can smell it, touch it. Anyone who watched the Pope’s visit on TV saw plenty of it. He waded into it: immigrants, homeless people, prisoners, babies attached to oxygen. Francis knows how to speak to pain.
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Ever Heard of “Death Cafes”?

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Recently the Associated Press carried a news item about “Death Cafes.” They involve meeting up with a group of people you have never encountered before and talking about death. Not an easy conversation, to be sure.

Still, advances in medicine, the aging of our population, and increased longevity are conspiring to force us to be more realistic about the choices we make as we get closer to death’s door.

Take a look at the following article and then let us know your reactions.

http://m.apnews.com/ap/db_289563/contentdetail.htm?contentguid=PHH2FGnR.

Many thanks.

Carolyn and Sig

Let’s De-Mystify the ‘D’ word

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The ways to talk about death and dying are manifold. One recent example was a public comment by Japan’s Finance Minister urging older Japanese citizens “to hurry up and die.” Concerned about escalating medical costs for Japan’s burgeoning senior population, he issued this less than appropriate remark last month.

We recently learned of another way to engage in a discussion around the topic of death: start a “death cafe.” Conceived by a Swiss sociologist, the idea has spread to the U.K., France, and most recently Columbus, Ohio. A death café, we are assured, provides a respectful and confidential setting for persons to share their thoughts about the kind of death they envision for themselves.

While Carolyn and I practically gagged when we first read the term ‘death cafe,’ we feel the concept is worth examining. For too long the topic of death has been among the ‘forbidden fruit’ of polite conversation. The idea of a formal setting in which to discuss death (whether it’s called a death café or something less blunt) brings the subject of death out of the closet.

Think about it:
Why not ask a loved one who may be dying what kind of funeral he or she would like to have?

Why not ask ourselves the same question?

Do we want to die in a hospital or at home or somewhere else?

In sum, wouldn’t we be better off if we could openly discuss the kind of death we envision for ourselves?

I suggest we all try it if only once. Consider discussing with a relative or friend the kind of funeral they or you would like. Share with them how you hope to spend your final days.

It’s time we unearthed the tough conversation around death and what we’d like to happen when our ‘time’ rolls around.

Sig

A Living Will is Not Enough

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In previous postings we have exhorted you, dear reader, to make sure you have a living will or an advance medical directive so that your loved ones and your doctor will know what kind of care and, eventually, death you wish to have.

In the past we have referred you to Five Wishes and to the Annual Health Care Decisions Day (the next one is April 16, 2013) as important resources. But instructions and documents are not enough. The process is incomplete without a conversation with your children, your parents, spouse or anyone whom you want involved in your end of life care.

Completing an Advance Medical Directive can be a challenge. But what people often find more difficult is the conversation that needs to take place before preparing the document.

Let’s face it: Too many people are dying in ways they wouldn’t choose, and too many of their loved ones are left feeling bereaved, guilty, and uncertain.

Which brings me to The Conversation Project. Founded by the noted columnist and writer Ellen Wilson, it is a resource to guide us through the often sensitive process of discussing end of life plans with loved ones. Ellen writes that she didn’t have this conversation with her Mother before she got dementia. As a result she was faced with myriad decisions she had no way to resolve because she never had “the conversation” with her Mom.

For those of you who are unsure when and how to have the conversation with a loved one, check out www.theconversationproject.org. It features an easy-to-download guide to initiating and carrying out these talks that should make the process much easier.

Sig Cohen

The Toughest of Conversations?

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How do I want to die? Where do I want to spend my last days? And with whom? These are some of the questions thoughtfully posed by the award winning documentary, “Consider the Conversation.”  

This 2011 production is a rare find. Consisting of interviews with hospice workers, doctors, an ALS patient, and numerous others, it raises profound questions about how we both hope and plan to spend our final days.

In an accompanying study guide (www.considertheconversation.org) the producers state that their goals include changing the commonly held American view that end-of-life is a failed medical event rather than a normal process rich in opportunity for human development.

Second, they seek to inspire dialogue between patient and doctor, husband and wife, parent and child, minister and parishioner.

Third, they want to encourage medical professionals, healthcare workers, and clergy to take the lead in counseling others about end of life issues.

The documentary does not offer answers. Instead, it provides questions all of us need to contemplate and answer for ourselves. The film elegantly aligns these questions with the concept of advance care planning which is all about talking with patients and loved ones about their end-of-life wishes, documenting them, and taking action to ensure they’re honored.

Other questions the film asks are: At what point is the quality of life no longer worth the emotional and physical costs of maintaining it? When is it OK to acknowledge that one has fought the good fight and it’s now OK to accept moving to the next phase? Have we had a tough conversation with our doctor about end of life planning? Will our doctor be honest and courageous enough to tell us when there is no more she can do and not consider that a medical failure but a fact of life? When is enough, enough?

Every so often we find a resource that challenges us to engage in a Tough Conversation. So it was with Five Wishes which provides a caring and intelligent approach to creating a Living Will. How to Say it to Seniors by David Solie is another gem that guides our thinking about what it means to be an elder and how to communicate effectively with elders. And so it is with Consider the Conversation, a thought provoking journey into what too many of us consider taboo territory.

For PBS listing or to purchase the film see www.considertheconversation.org.  

Sig Cohen