“You have a new referral. The physician is worried that Mrs. B is depressed and suicidal; she’s been talking about dying all day long. They plan to up her meds if she keeps talking about that.”
Mrs. B does want to talk about death. She’s recently diganosed with cancer, the 4th time in 9 years. This time it’s spread to her lungs. Her problem isn’t one of depression or suicidal ideation. She just doesn’t know how to talk to her family about it.
“I am ready but I am worried about my kids. I don’t think they want to talk about it again. We’ve discussed it before. They already have copies of my Five Wishes… What should I do?”
Most of us don’t like to talk about death and dying. Those of us who do are often labeled as strange or socially maladroit. In the past few years, websites like The Conversation Project have encouraged a more open and honest discussion of one’s end-of-life care with loved ones and healthcare providers. In many ways, it helps individuals and their loved ones prepare for the dying process and life beyond death.
What have received little attention is the frequency of these conversations, particularly among individuals with chronic health conditions and their loved ones. Year one of Parkinson’s disease may look very different from year six. A 15-year-old childhood cancer survivor may feel very differently about life and death than a 75-year-old survivor when cancer strikes again. Even after the 6th heart attack, family members may still have much difficulty understanding each other’s evolving wishes and worries.
We live in a world where a “quick-fix” is often the most desirable outcome. When death happens “slowly”, many of us have a hard time coping with the process. It is as if we could minimize the suffering if we didn’t talk about it. End-of-life care should be an ongoing discussion, not a dreaded item on a To-Do-List that one needs to quickly “get over with.” It is never too early, too late, or too often. The key is to be as person-centered as possible, without depriving someone of his or her right to speak up.
It would be a shame if we didn’t allow those who would like to talk about death and dying the opportunity to do so. As healthcare providers, it is disrespectful to frown upon individuals and caregivers when they change their mind from time to time. (So what if they do want to update their Five Wishes?) Equally distasteful are crude attempts to pump someone with drugs merely because he or she is expressing fear and sadness, without carefully probing the cause.
Ultimately, we must ask ourselves, who in the room is actually afraid of death and dying? Are we making it even more challenging than it already is?