Hard Conversations

Consider this as a public service announcement.

In many hospitals at this moment a small group of family members has gathered because another member of the family group is ill or injured—perhaps even near death.

Here is an abbreviated version of that difficult conversation.

Child #1: This is totally freaking me out. How did he ever get to this point? Why didn’t someone tell him and us that this was this serious?

Child #2: You are always so busy that you never had time to have much conversation about this. Some of us could see it coming.

Child #3: Well, we are clearly at the point of deciding about the next step. The medical people are telling us that they have done all they can, and they need instructions from us as to our wishes.

Child #1: This is completely unacceptable. You mean you are going to just let them stop treating him without pursuing any possible further treatment?

Spouse: He and I have talked some about when we might die, but we never really had a serious conversation; he never really seemed to be willing to talk about it much. I am so upset that I feel almost paralyzed.

Child #2: We have been in this hospital and this room for six days now and they have been doing all kinds of tests on him and do not seem to be learning anything positive. They don’t talk to us about what they are thinking, but it seems to me they are discouraged about him getting better.

Child #3: Yes, I sense that the medical people need guidance from us as to how much effort to continue. I like their compassion, but they, logically, want to know from us how much treatment we want for him.

Spouse: Well, like I said, he and I have talked occasionally about this possibility, but we didn’t feel the need to make any decisions or set anything up in advance. It was just too hard of a consideration to have, I guess.

Child #2: I wish we could ask him right now what he wanted; we are just floundering without knowing his thoughts or desires.

Child #1: Well, we can’t just let him die. That is not what he would want.

Child #2: How do you know that’s not what he would want? You live hundreds of miles away and seldom come to visit. You are mostly out of contact with the family.

Spouse (crying by now): Stop it all of you. We must make a decision that we all can agree on. That’s what he would really want. I wish he could speak for himself right now.

In reality, this conversation would be longer, and the intensity would continue to increase. Everyone seems frustrated. They have encountered a situation that, intellectually, they knew was inevitable, but they had been able to keep it at a distance emotionally. That is no longer possible.

My chaplain work frequently positions me on the periphery of these family discussions. If only they and the patient had spoken truthfully about this before now.

Reading friends, if you have not had these family conversations before, now is the time. As intimidating as it is, you need to make some plans in writing concerning the reality of a health incapacitation. There are professionals who can help you plan for this future and there is substantial online help and sample forms.

My suggestion is that you understand and implement written instructions in two areas. The most straightforward area is financial. The Power of Attorney document appoints an agent who (upon patient incapacitation) has the authority to perform such tasks as paying bills and managing financial accounts, legal and tax matters, and buying and selling property.

Second, a Medical Power of Attorney is an agent appointed as the advocate and medical decision maker should I become incapacitated. Simply put, this person is responsible for making medical decisions for me; this trusted person and I will have had multiple conversations about my wishes, and the person is delegated to carry them out.

If all this is making your head spin, that is understandable. The consideration is also unavoidable. Having written documents and appointments made will not make grief go away, but it will at least address some of the immediate pressures of the end of life. We owe these future conversations to one another.