Monday, February 21, 2005

The Discordant Family - Part 2

Again, I don't think there are wrong answers to these scenarios so long as our intentions are good. And sometimes there is no answer that fits well. This is definitely one scenario that I continue to grapple with (see previous post if you are just now joining us).

I have been involved in numerous types of responses to this scenario. One time, a doctor and the patient alone made all of the decisions, the patient signed the paperwork and immediately fell into a coma. I was then left to deal with the aftermath with the family. Although, yes, it is ultimately the patient's decision, if that decision is made without the family's involvement, that can be very painful for everyone involved - the family, the health care providers and ultimately the patient, as they may sense the intense distress of their family at the end. This was not the most peaceful death from that perspective.

Many people have DPOA's (Durable Power of Attorney). A DPOA is someone who can made medical decisions for you when you are unable to speak for yourself. Although I am generally strongly in favor of DPOA's because they can look after your interests if they know and respect them, there have been cases where the patient decided they were ready to die, but when they slipped into a coma, the DPOA stepped in and refuted that decision.

There are so many ways for this scenario to be played out poorly.

I like JennyNYC's idea of trying to bring hospice up as if it were their idea. If it works, brilliant!

I agree with Jeremy's comment that the family is being selfish by not letting the person who is dying go. But I would also argue that it's selfish for the dying person to make that decision without at least "hearing out" their family. I've seen families split in two over these decisions and afterwards I am left wondering if they ever made ammends. I do not think of those as "good deaths." It's all about relationships and trying to keep open, constructive communication. In life - before dying becomes imminent, we all struggle with these same issues. How do we do what's best for ourselves while still being compassionate to the ones we love? Has anyone not grappled with that dilemma? Has anyone mastered it? If so, let me know! :-)

These scenarios likely arise from a lifetime of discordance in these families. The changes that could truly benefit these families are not lessons that can be easily taught at the bedside when you're in your last days. These are ways of being that need to be practiced throughout a lifetime.

I am not Buddhist. As I've mentioned before, I don't have a religious creed. But I try to find wisdom everywhere - in my patients, in my teachers, in my friends and family and in myself - and in my blog readers! :-) But the main thing I've picked up from Buddhism is to be compassionate. It is a lot harder to have all of this conflict when families are compassionate with one another and with staff and when we are compassionate with the patients and their families - and with other staff (that could be a whole 'nother post there). And although compassion cannot easily be taught overnight, my best response to these situations is to work even harder to practice and demonstrate compassion. I listen to the family express their pain and anger and sorrow and try to sympathize as best as I can. Believing your feelings have been heard goes a long way towards acceptance of even the most undesirable of life's experiences. Most of us bloggers should know that, right? Why else do we write about the bad times?

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