Tough Conversations

Solutions Through Compassionate Communication.

Moving Beyond Fear

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“Don’t move the way fear makes you move.” This line from the poet Rumi is good advice for a tough conversation.

Fear moves us toward anger or withdrawal. Toward hasty, negative assumptions. Toward defensiveness, self-justification. Or we can’t move at all:  we’re paralyzed.

Rumi says, “Keep walking, there’s no place to get to. Don’t try to see through the distances.” I’d say, “Keep talking, though you don’t know where it will lead.” The “not knowing” opens new possibilities.

But to keep talking you have to start. Many necessary conversations never begin because of fear.  Fear of being hurt, of hurting the other, of another’s rejection or anger. Going deeper, there’s the fear of being wrong, of having to change. Of having to apologize. Or forgive.

Okay, so how do we move away from fear?

Say the issue is a parent’s failing health and unexpressed last wishes. One way is to ask yourself, “If we don’t have this conversation, what’s the best thing that can happen?”

Maybe Mom will die peacefully in her sleep and you’ll never have to talk about medical powers of attorney or directives.

But you can’t bank on that. So what’s the worst possible outcome?

A parade of horribles comes to mind: disagreements with Dad and/or siblings about hospice, heroic measures, feeding tubes, hydration. Something Mom might hate if she were able to speak for herself. Prolonged suffering. Astronomical medical bills. Guilt. Blame. Family estrangement that survives Mom’s death.

This best-case/ worst-case analysis can move us from the fight/flight state of mind to a calmer starting point. Focus on Mom’s needs and the family’s love for her and try to put that into gentle words. “Mom, there’s something I’d (we’d) like to talk about. But it’s hard to know how to begin. We need to know your thoughts. Can we talk?”

Don’t move the way fear makes you move. Acknowledge the fear, then move with compassion through the fear to a solution and deeper family understanding.

Carolyn

Tube Tales

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(The following stories are true; only the names have been changed.)
1. My friend Linda’s grandmother was in a coma. The doctors had put her on life support. After several months in this condition Linda’s mother, Gail, was unsure how to proceed even though she was named grandmother’s health care proxy. So Gail invited the 12 closest family members to grandmother’s bedside. Once assembled, she asked them to vote on whether to remove life support. Nine voted yea; three nay. Life support was withdrawn, and grandmother died within hours. The three nays realized that removing life support made sense and were relieved to know that grandmother expired painlessly.
2. Twenty years ago Stuart moved to Washington having renounced his family ties. We knew nothing about Stuart other than he had previously lived in upstate New York. Stuart developed a virulent form of abdominal cancer, which went untreated. While visiting a friend his condition deteriorated such that he was taken by emergency vehicle to a nearby hospital, placed on life support, and administered morphine. Stuart had no living will nor a DNR order. (Do Not Resuscitate.) His friends were at a loss how to proceed as was the medical staff. After three days the doctors decided to reduce the morphine drip to the point that Stuart regained consciousness. When he did, a doctor asked him what he wanted to do. Stuart mumbled that he wanted to ‘go home.’ His answer gave the doctors sufficient justification to remove life support and transfer him to a hospice where he died a few days later.
3. When my cousin Joan’s mother was admitted to the ICU of a local hospital, it was clear that she might never regain consciousness. Joan’s older brother, Sam, was her mother’s health care proxy. Both Joan and her younger sister Carol did not want their mother to remain indefinitely on life support. Sam did, and because he was named health care proxy, he prevailed. Their mother remained in a coma for the next two years before she passed away. Given the sisters’ anguish over their mother’s prolonged coma and the huge cost the family incurred, they haven’t spoken with Sam since.
Moral of the stories? Plan ahead. Make sure that everyone in the family whether they suffer from a chronic disease or not has a living will or a health care power of attorney, or proxy. Try to reach consensus on whether to use life support or allow nature to take its course. One of the best tools we’ve found is “Five Questions” which has become America’s most popular living will because it is written in everyday language and helps start and structure important conversations about care in times of serious illness. See www.agingwithdignity.org.
Sig Cohen