Blog post by Lisa Fields
This week is Thanksgiving in the United States. We thought it’d be fun to use this holiday theme for this week’s #HCLDR, much like we did last month when we had a Thanksgiving chat with our Canadian friends (they celebrate about a month earlier). Please join us Tuesday November 26th at 8:30pm Eastern (North America)…and thank you in advance 🙂
- T1: As healthcare leaders what are some of the complications that occur when people don’t document their end of life wishes?
- T2: How could healthcare leaders increase the percentage of patients who document their end of life desires?
- T3: If you could change one thing that’s currently impacting our end of life situations with patients what would it be?
- Closing Thought=CT: What’s one thing you’ve learned tonight that you can take to your place of influence to help a patient tomorrow?
I love Thanksgiving. The smell of the turkey cooking, onions and celery being chopped for the stuffing, and the sound of the Macy’s Thanksgiving Parade drifting from the TV were constants in my life as a child as we prepared for the big day.
Grandma and Grandpa Fields always gave us a remarkable Thanksgiving experience. My Dad was the oldest of four active boys. The house was filled with lots of people, some were family members; others were friends. Thanksgiving for us also always meant sharing this holiday with the international graduate students my grandparents hosted. I’m not sure how she did it but my grandmother always had enough china, linen table cloths, and all the extras that added beauty and elegance.
Even better than the food and her beautiful dinner table was the conversation that took place on those holidays. Politics and a heavy dose of male teasing were always part of our day. I always enjoyed listening to the family stories told over and over again. There was the time my grandfather declared comic books were “bad” for the boys and then read a stack before falling asleep. In the middle of the night he awoke to find a cold hand on his face. He was terrified! In the end, he realized he had fallen asleep with one of his arms pulled around his neck so when he woke up his hand was cold because he cut off some of his circulation. The cold hand on his cheek actually belonged to him. Another family story centers on whether or not my Uncle George actually drooled on the turkey when he was in charge of carving the big bird.
I can’t think of a single topic that was “off limits” during our Thanksgiving celebration. But, perhaps like most families, the topic of our end of life wishes didn’t happen to come up. However, gatherings like Thanksgiving can be good time to discuss our end of life wishes. While it might sound rather morbid, there are a number of tools like @engagewithgrace that can actually “kick-start” discussions regarding end of life wishes.
Certainly we might have family members who object to this discussion during Thanksgiving. In order to be prepared for those who might object here are some points to ponder.
In a remarkable article for The New Yorker, “Letting Go: What should medicine do when it can’t save your life” Atul Gawande MD shares, “Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others.” If we don’t have end of life conversations how will we know what our loved ones want?
The Pew Research Religion and Public Life Project just published “Views on End-of-Life Medical Treatments.” The report states “Roughly one-quarter of U.S. adults (27%) say they have given either no thought or not very much thought to their own wishes when it comes to end-of-life medical treatment.” With such a small percentage of adults, especially older adults, not even thinking about their own death, the work for healthcare leaders becomes more complex.
My former husband is a minister. For thirteen years, as part of a clergy family, I had the opportunity and honor of being part of the some of the most joyful and difficult times some families experienced. Death is always difficult. Some of the most difficult and sometimes most gut wrenching experiences with families happened when folks simply didn’t know what their loved ones wanted if they had not or were unable to express their end of life wishes. Sometimes I would see families torn apart under the strain of trying to figure it all out.
This Thanksgiving is special. My daughter Ally, a college sophomore, has invited me to her apartment in Asheville, North Carolina to celebrate the holiday. I’m going to pack one piece of china or cut glass and give it to her as a way to honor the tradition of our family. I’m also going to pack the @engagewithgrace questions for us to fill out together this Thanksgiving. Now I’m not naive enough to think Ally will be thrilled to discuss our end of life decisions but I also know she has seen the challenges that occur with families when this topic has not been explored.
I wish the best Thanksgiving ever for all of our healthcare leaders who will celebrate this week. I hope all of us will find way to share the importance of discussing our end of life wishes both professionally and personally.
Drane, Alexandra Matthew Holt “Engage with Grace” http://www.engagewithgrace.org/Default.aspx, accessed on November 23, 2013
Regina Holliday. “Painting a Gift for Alex Drane, 2011” (January 9, 2011)
http://reginaholliday.blogspot.com/2011/01/painting-gift-for-alex-drane.html, accessed on November 23, 2013
Pam Ressler, RN. “Engage with Grace this Thanksgiving, 2011” (November 23, 2011) http://pamressler.blogspot.com/2011/11/engage-with-grace-this-thanksgiving.html accessed on November 23, 2013
Susannah Fox. “Engage with Grace over Thanksgiving, 2010” (November 24, 2010) http://e-patients.net/archives/2010/11/engage-with-grace-over-thanksgiving.html, accessed on November 23, 2013
“Views on End-of-Life Medical Treatments, 2013.” Pew Research Religion & Public Life Project, Washington D.C. (November 21, 2013). http://www.pewforum.org/2013/11/21/views-on-end-of-life-medical-treatments/, accessed on November 23, 2013
Atul Gawande, MD. “Letting Go What should medicine do when it can’t save your life?. 2010” The New Yorker, New York, NY (August 2, 2010). http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande, accessed on November 23, 2013