Care Triad

Giving thanks

As Thanksgiving approaches, I am thinking a lot about the death of my father in early November 2011. I am thankful that my mother and I had the strength to bring him home to die with dignity, surrounded by his family. I feel blessed that my father lived a long, productive life and that he did not spend his last weeks or months in a hospital bed receiving treatment to prolong his life but not necessarily prolong the life he wanted to live.

Death is not the enemy of life, it is a part of life. As Steve Jobs said in a commencement address at Stanford University in 2005:

No one wants to die. Even people who want to go to heaven don’t want to die to get there. And yet death is the destination we all share. No one has ever escaped it.

And yet, we often fight it, even when there is little hope of meaningful life.

Although we are living longer as a society, most of us have not given any thought to how we want to die and have certainly not discussed our wishes with loved ones.

Studies show that the majority of people would prefer to die at home and yet the majority die in the hospital. Why is that? Part of the problem is that medical professionals have a hard time letting go when there is a treatment that could work. And part of it is that we feel pressured as loved ones to “do everything possible” and “not give up” even when there is little chance of meaningful life. In the past few years, a number of my friends have watched their elderly parents die long, painful deaths in the hospital after undergoing major surgery that was “successful” but resulted in the rest of the body being unable to recover from the strains of the surgery. We can do better.

Hospitals are not friendly places to be. My father hated every minute of his multiple hospitalizations – not being able to get help when you need it, being called by the wrong name, being asked the same questions by every member of the healthcare team, not being able to get a good night’s sleep and being taken for tests without being told why they were being done. And that doesn’t begin to address the complications that were directly related to being in the hospital (such as infections) and several poor surgical outcomes despite going to well-respected surgeons.

The healthcare system can do a better job of helping us make informed decisions about the type of treatment we want to receive and the potential outcomes of that treatment. But we can do a better job of understanding what our loved ones want in case they are unable to make decisions for themselves.

Thanksgiving is a great time to begin the conversation, when we are gathered as a family and thinking about the things in life for which we are thankful. There are a number of organizations that can help us get started. Engage with Grace has developed an excellent set of 5 questions we should know the answers to about our loved ones including where they would choose to die. The Conversation Project is another resource with materials to help guide the conversation. I recently leaned about a campaign called “Let’s Have Dinner and Talk About Death”. These are just a few of the many resources available. It doesn’t matter how you start the conversation as long as you start.