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Breaking the Bad News (Cont.)

April 23, 2012 By Carolyn Parr 2 Comments

Last week Sig asked: If you had a fatal illness, who should tell you? Your doctor?  A  loved one?

How should they say it?

My Dad, 93, was slowly dying. His body was riddled with the prostate cancer he’d lived with – and minimized — for 20 years. He’d signed an advance directive (“no extraordinary measures”) and a health care power of attorney. But he’d made clear that his own death was not a topic of discussion.

One afternoon he told us to call an ambulance. “I just don’t feel right,” he said.

Early next morning, in the hospital, he suffered a massive heart attack. A doctor met me in the hall. “He doesn’t know what happened. We don’t want to frighten him. There’s nothing we can do. We’ll make him comfortable. He might last 24 hours.”

I was sad but not surprised. Dad had fought the good fight. I went in to hold his hand.

He was alert, even cheery. He pretended nothing had happened. “I feel pretty good,” he said through his oxygen mask. “I hope the Redskins win tomorrow.” Denial, full strength. He was not going there.

But a few hours later he asked, “Why aren’t they treating me?”

I tried, “Well, Dad, maybe there’s nothing they can do.”

He was furious. “I’ll fire them and get a new doctor!” He tried to climb out of bed.

When a female doctor appeared a couple of hours later I privately asked her to tell him.

She was kind. She sat beside him, at eye level. She was indirect and used a lot of silence to let him absorb each sentence. She emphasized the things he could control.

“Mr. Miller, your daughter tells me you’re wondering about treatment.” Pause. He nodded. “You’ve suffered a heart attack.” Pause. Nod. “It wasn’t a little one.” Longer pause. “I’m afraid it did a lot of damage. . . . . . We can’t fix it.” A really long pause.

“And you know you also have cancer. . . . . that has spread,” she continued. “That’s why you can’t keep food down.” More silence.

Finally,  from Dad, “How long?”

“Not weeks.” [Her phrasing astonished me.] . . . . “Is there anything you need to do?”

Dad looked at me. “No. You’ll take care of Mom (in a nursing home with advanced Alzheimer’s), you know about the money . . .” Then he described the funeral he wanted.

The doctor told him he could choose hospice, he could control his pain medication, and he could decide whether he wanted to go home or stay where he was.

When she left, Dad said, “She said I have two weeks.” Nobody argued with him. He lived four more days.

Carolyn Parr

Filed Under: Blog Tagged With: advance directives, death and dying, denial of death, fatal illness, health care POA, Hospice, talking about dying

Passing the Buck on one tough conversation

April 16, 2012 By Carolyn Parr 2 Comments

Last week my friend Gail told me she was put into an extremely difficult situation. Her mother’s oncologist called Gail to inform her of her mother’s terminal cancer and asked Gail to break the fateful news to her mother. By way of background Gail and her mother live in different cities. And Gail’s mother had an appointment with the oncologist two days later.

What should one do in a situation like that? How ethical is it when your mother’s doctor relies on you to inform your parent that she has an untreatable cancer?

Isn’t it the doctor’s responsibility to do that? How should one frame a message that is so heart-wrenching as informing your parent that her days are literally numbered. Once you’ve taken that step and bravely, and perhaps tearfully, broken the fateful news, how do you respond to such questions as: How serious is the cancer? How long do I have to live? Are there treatments that will possibly cure, or if not cure, delay the inevitable? And worst of all, what should Gail’s reply be if her mother asks: “What do you think I should do?”

Well, Gail broke the news to her mother. It couldn’t have been easy telling your parent that she is going to die…soon. Gail also promised to come home to accompany her Mom to her appointment.

Gail’s mother received the news with equanimity. Knowing that Gail’s knowledge was limited and that she had an appointment with the oncologist two days later, her mother had only one request of Gail: that she be strong because she would need her daughter’s fortitude and love more than ever in the months to come.

Sig Cohen

Filed Under: Blog Tagged With: "You're going to die.", death and dying, fatal illness, talking about dying, Telling someone they are dying

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