At Peace by Samuel Harrington

Author:Samuel Harrington
Language: eng
Format: epub
Publisher: Grand Central Publishing
Published: 2018-02-06T05:00:00+00:00

VISUALIZE THE QUALITY OF YOUR FINAL DAYS

While it is sufficiently easy to find what defines a median survival of six months for most conditions, it is emotionally and intellectually difficult to project that onto one’s personal situation. However, it is well worth the effort—only those people who recognize their decline have the opportunity to take some control back from their treating physicians.

A chronic decline offers more time for this recognition to take place. Patients with a specific diagnosis, especially one that is universally recognized as a terminal illness (advanced cancer or end-stage heart disease, for example) have an advantage over those suffering the cumulative insults of old age. The former patients can easily get their hospice and home care team in place and trained for the inevitable. The latter have to do some extra work to get admitted to hospice. I will go through this process in detail in chapter 11: Hospice Care.

Practically speaking, it is a useful construct to divide terminally ill patients into three broad categories: those transitioning from a terminal diagnosis to a terminal condition with recognizable and quantifiable diseases (cancer, CHF, COPD, etc.); the sentient elderly who are failing to thrive (like my father); and the otherwise healthy but demented.

Recognizing the development of a terminal condition is critical because by doing so a patient can predict an exit opportunity and designate an exit strategy—an acute illness that, when ignored while superimposed on a terminal condition, will lead to a comfortable and timely passage.

Unfortunately, whenever these discussion points come up at a dinner conversation, some offended listener, usually a well-meaning friend or relative, argues, “You’re just telling people to give up and die!” But that is not what I’m saying. What I am saying is, “Get educated; be aware; question aggressive therapeutic recommendations; question overly optimistic promises; exercise judgment.” When the time is right for you, exercise aggressive passivity.

Harsh treatments toward the end of life might help a few patients live a little longer, but these same treatments have no effect (except side effects) for most elderly people, and they kill many people sooner than the disease itself. In fact, studies show that stage IV lung cancer patients live longer on average when they seek early palliative care than clinically matched patients seeking aggressive treatment.6 Similar studies have been done in advanced breast cancer and pancreatic cancer patients with similar results. In those cases, choosing treatment over palliation increases the risk of painful and ineffective treatment, loss of control, and even an earlier death.

If you know your days are numbered, you know the “why” of your death. Ask yourself how you want to spend those days and visualize the “where” of your death. Do you want to spend them in a doctor’s office, treatment center, nursing home, or hospital? Or would you prefer to spend those days with friends and family? Acknowledging a terminal diagnosis prepares a patient and their family to recognize a terminal condition. This is a variation on having a vision of how to die.

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