Archive for Talking About Dying

DNR and POLST Forms on the 8th Day of the Week

I once talked with my parents about their end-of-life wishes before dessert was served.

When Mom was alive, we talked every Saturday. I miss that. A pre-dawn riser by habit, I could phone her in California for a relaxed early morning chat regardless of where I lived. One year, anticipating Thanksgiving, our weekly ritual included my suggestion that she and Dad talk about a serious topic with their “kids.”

She agreed. At Thanksgiving, they’d let us know their wishes.

I did not anticipate this request would become Mom’s announcement after the second helping of turkey was offered, but prior to choosing between pumpkin or apple pie for dessert. With mashed potatoes cooling on my plate, with my two sisters and our spouses ‘round the table enjoying the Thanksgiving feast, Mom said . . .

“Larry thought we should tell you what we want when we’re dying. Your father and I don’t want to be hooked to machines keeping us alive. Just let us go.”

Those likely weren’t her exact words. But even if my smarter, better-looking sisters disagreed with my memory, that was darn close to what and how Mom announced their wishes.

Every family is different! Happy Thanksgiving, eh? Read More →

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Death is (Not) the Enemy

Hospice always fails you. With few exceptions, our patients . . . die.

Death is a defeat, often perceived as a human failure.

Death is to be battled, and everyone schemes to beat it.

Death is a problem to be solved. On the moon-bound and suddenly crippled Apollo 13, Commander James Lovell famously said, “Houston, we’ve had a problem.” The prospect of death, between earth and the moon, between our first wail as a newborn and before whatever last breath is taken, should be confronted and conquered.

Avoid death!

Anyone working in hospice has joined the grim reaper gang. We mingle with the life insurance sellers and funeral directors, the coroners and the grave diggers. We are purveyors and surveyors of the forbidden topic. While the rest of society runs from the dying, we stay.

A hospice nurse, training similar to her counterparts in the hospital corridors and emergency rooms, begins the day with a list of patients to visit. While her colleagues are calming a mother about to give birth or prepping for surgery, and will give their all to bring and extend life, the hospice RN has other thoughts . . .

  • Will my patient die today?
  • How can I help her or him die peacefully?
  • How can I honestly answer the family’s request to know when death will come?

Read More →

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In Hospice, Don’t Be Ruled by the Rules

During a patient care team meeting, the hospice medical director explained that he’d broken one of his rules.

My distant impression of the doctor—physically distant because of where he and I sit in the meetings and professionally distant since he cares for the patients in their dying while I support grieving families after death—is that rules are critical values for the way he lives his life.

However, the soft-spoken physician felt he had to break a rule. Instead of providing key information about the disease process, and the options for comfort care so the patient could make choices about the next steps, the doctor bluntly told a patient that he must be transferred from his residence to our in-patient hospice home. Now! There, the patient would have a better level of care for his needs. Moving was not his choice; it was the doctor’s demand.

The patient died before the next sunrise. He died with the sole member of his local family at bedside. For weeks, his dying had been lonely, problematic, and anguished. In his last hours, dying became peaceful. The doctor had used good judgment. But the doctor had also wrestled over “breaking” a personal, essential rule: whenever possible, let a patient take the lead in making an informed decision. Read More →

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