A Difficult Conversation

/ September 22, 2010

A recent article in the New Yorker, Letting Go discusses various perspectives of those people who are affected by someone who is terminally ill.  The author, Atul Gwande researched and followed patients ranging in age and illness, some of whom had chosen aggressive treatments for potentially terminal illnesses and others who chose hospice care.  The research involved interviews with doctors, patients and family members and highlighted the success of hospice care in reducing trips to the ER, managing pain and well-being, and sometimes even extending the life of terminally ill patients.  Although there wasn’t a definitive answer regarding the correct type of treatment for any of the patients, the article illuminated the significance of discussing illness and treatment with family before it is too late.

The lesson for me

The next day, I called my mother.  I explained what I had read and we talked about the concept of hospice care.  I, of course, added my two cents of support for having a well-drafted health care directive.  In turn, my mother shared something with me about my grandmother who died six years ago after a three-month battle with cancer.  Upon her diagnosis, my seemingly strong and healthy grandmother decided to forego treatment and instead, live her last few months as comfortably and pain free as possible.  Although she knew that it was her decision to make, she asked my mother and my uncle for their approval of her decision.

I am not sure if my grandmother knew that medicine would not save her, but I think that she didn’t have the energy to withstand aggressive chemotherapy.  My grandfather had recently died and although she had won her first fight with breast cancer thirty years prior, she was just plain tired. In our sadness, we all understood and supported her decision.

The lesson for everyone

The concept of discussing all treatment options with family members, including the non-traditional treatments offered by hospice programs, is one piece of the process that I had not previously considered.  I learned in the New Yorker article that family members sometimes persuade their loved ones to seek out the most aggressive treatment, even if it means more pain and suffering.  At times, this is not what the patient wants, but they feel guilty for accepting the fate of their illness.  Encouraging the patient to try every possible treatment is not an unnatural inclination for family members and loved ones of someone who is ill.  I am sure that before reading this article, I would have done the same.

Since I am in the business of encouraging individuals to consider their mortality by creating wills and health care directives, I often think about how these huge life decisions impact those around us.  With this new perspective on the use of hospice care; I have a slightly better understanding of the difficult personal decisions made by individuals who are terminally ill.  I hope that everyone considers the importance of an open and honest discussion with loved ones about end of life issues before it is necessary.

PHOTOGRAPH: PHILLIP TOLEDANO, “BIRTHDAY BALLOON,” FROM “DAYS WITH MY FATHER” (2008) 

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