End Of Life Conversations

When is The Right Time to Have Such a Conversation?

There is never a right time to discuss end of life issues. But the issues can quickly become a fact of life, oftentimes when you least expect it. Few people are physically or emotionally prepared for these types of conversations and the decisions they may require. Many think that this conversation only deals with end of life requests and final wishes. While these topics are important, the end of life conversation needs to take place so that the patient feels supported and comforted by knowing that s/he is not going through this crisis alone. If the person close to you is very ill and the doctors think that it is time to discuss the end of life, there are a few things for you to think about before you have that conversation.

What the Dying Patient Wants to Talk About:

When bodily functions start to slow down and their condition continues to deterioarate, alert patients will sense that their life is slipping away and that death is eminent. The majority of patients will want to share their thoughts and feelings with loved ones at this time. They want to know how their loved ones feel. They want to reminisce. They want to be reassured that they will not die alone. They want to be reassured that their family will be okay. They want to say good bye. They want to know that they will be missed. They want to know that they have brought value to the lives of family and friends.

Why Families Don’t Have These Conversations:

If you ignore the inevitability of death and do not have this important conversation with your loved one, you leave that person alone to face this most difficult final journey without the requisite love and support so critical to a peaceful death. There could be nothing worse than facing the end of your life with everyone around you in denial, pretending that it is not happening. It is frequently a lack of words that keep people from communicating, along with the fear of showing emotion. Family and friends don’t know what to say. They hold back tears. They hold back fears. They hold back touch. They hold back feelings. And ultimately, they come face to face with their own mortality.

What Do You Say During These Conversations?

Begin by expressing your deep feelings for the person who is dying. If that includes love, express the love you have for them. Or, express a deep feeling of appreciation for the relationship you have shared, for the value they have added to your life. Do not be afraid to cry. This shows you truly care. Express your support and commitment to be with them through this part of their final journey. Give them the information they need to empower them to make their own decisions. Being in the room with the dying person provides comfort. Don’t be afraid to ask the patient if they have any final requests. Be their advocate. Make sure all of their physical, emotional and spiritual needs are being met. Offer to have their clergy come visit. Be present for them. Sit close. Make eye contact. Touch them. Hold their hand. Rub their back. Don’t be afraid to joke, to laugh, or to cry when appropriate. Be honest and upfront. An honest ending can be extremely soothing and satisfying for all involved, regardless of the history of the relationship.

Learn more: The National Cancer Institute has many articles about end-of-life concerns. Access them at https://www.cancer.gov/

Anecdotes:

Sometimes laughter is the best medicine. When my elderly mother was dying, of leukemia, I had such an end of life conversation with her. Against my brothers wishes, I told her that the medical news wasn’t good and that her time was limited. I expressed this out of love and support for her. She was awake and alert and I felt that she deserved knowing what was going on. She also deserved the opportunity to have the conversation. The morning after we had this conversation, she was presented with several medical options which she wanted to think about. The next day I asked her if she had any last requests and she asked me if I had any suggestions. I said that if it were me I would be asking for McDonald’s french fries. We had a good laugh.

I was the middle child in a family of 3 sisters. I was always different than my 2 sisters, and I always felt like the odd one out – like a fish out of water – when I was with the family. The last time I saw my father alive I was 48 years old. He had just been diagnosed with metastatic pancreatic cancer and had been transferred to a hospice floor in a local hospital. As I kissed him good bye, knowing that this would probably be the last time I saw him alive, I leaned over and tearfully whispered in his ear “Daddy, just tell me once that I was your favorite daughter.” He never responded…. and 5 days later he was gone. There are times when end of life conversations can comfort those left behind. In this case, I was denied the comfort of having closure with and validation from my Father in those last few days before he died.

When to Begin Hospice ” – 3:30 minutes