In this podcast, Dr. Ira Byock highlights the importance of healing old relational wounds. I am excited to share this because many of the people I see for grief counseling would be in far less pain today had they had the opportunity to have these sorts of conversations with their loved ones. While still very possible, it's much harder to reconcile old wounds when the other person is no longer here. Should you have the opportunity now, consider your future grief and don't wait.
Dr. Byock advises four statements that can guide these conversations. I think they can also be a useful way of understanding about what grieving people need to reconcile before they can move forward following a death.
- Please forgive me
- I forgive you
- Thank you
- I love you
Listen to this fantastic podcast, or give me a call 720-515-9427 if you would like help mending or clarifying your relationships before you or a loved one dies.
The typical debate about hospice care vs. aggressive medical treatment is one of quality vs. quantity. Hospice care emphasizes symptom management and emotional support, ideally leading patients and families to have a higher quality of life. Aggressive medical treatment emphasizes curing or stalling an illness, ideally leading patients and families to have more quantity of life. Research shows, though, that's not always the case.
This preliminary study examined these ideas and found that hospice was not associated with shorter survival. In fact, for some illnesses (CHF, lung cancer, and pancreatic cancer) hospice enrollment was actually associated with longer survival. Perhaps the conventional wisdom associating hospice with quality while aggressive treatment is associated with quantity is too limited of a view? There may be cases where hospice care can increase both the quality and quantity of a patients life.
Furthermore, this (false?) dichotomy between quality or quantity at the end of life disregards a little known, and important, third option I will write about at another time: palliative care.
We’re bad at talking about death. And yet, whether or not it’s conscious, most people have fairly specific wishes for how they want to die.
- Some prefer to die at home surrounded by family members whereas others prefer to die in a hospital to reduce the burden family members might feel
- Some prefer to know that their doctors will fight aggressively to the very end whereas others prefer more emphasis on the quality of their life once they have come to terms with what might be a low chance of recovery
- Some prefer making specific plans around finances or what a memorial service might look like whereas others might be less concerned with specifics than having their values considered when decisions are made
The most important step, though, is to have the conversation because the alternative can be disastrous. When people don’t talk about end of life wishes, patients often get what they don’t want and family members often end up burdened with the worst consequences. A well-intending family member might have no idea whether or not his or her loved one would have wanted to be put on a ventilator, or even worse, know when a ventilator should be turned off. They might feel guilty for the decision they do make; they might regret not having clarified things much earlier; And I’ve seen time and time again that not having these conversations can disrupt a family member’s grieving process, causing unnecessary harm for months or years following the death.
Many people prefer not to talk about death secretly hoping that if they ignore it, it will go away. Others imagine that these conversations can wait. But I’ve learned a simple mantra over and over again from my, sometimes intensely suffering, clients: Don’t wait. Find a way to at least begin talking about the most important conversation most of us never have.
Looking for places to start? I can be a resource, or you may want to start with these fantastic websites: