We’re all going to die someday.
Let’s talk about how you as an individual want to die. Some people won’t make the choice. They will be slicing onions in the kitchen and suffer a massive cerebral hemorrhage that will effectively kill them before they are on the ground. Most of us will have time to face death and decide how we meet our deaths though.
The Conversation Project has a good set of resources for people who want to start these discussions. What type of care under what types of conditions, prognoses and hopes do you want? Who do you want to make decisions when you can’t decide or communicate?
Medicare (and most private insurers) will pay doctors to have advanced care planning discussions with patients and their families. These discussions usually will come at either a well visit if they are generalized planning or at a sentinel sick visit for specific, prescriptive planning. The conversation can range from a desire to have everything done including super-heroic, low probability of success measures to aggressive curative attempts to enrollment in trials to curative care with a transition towards palliative or hospice care. Those are all choices that people can, will, and do make.
And these choices can and will change over time. That is okay. Communicate these new choices with the people you care about.
A few weeks ago I was back in Boston with my parents. My mom is retiring. Mom and Dad needed me to talk through all of their health insurance and Medicare options. They had done most of their homework over time so we came up with a plan that I think will work pretty well for their needs. And then we talked about how my mom, a former oncology and medical/surgical nurse was doing her advanced care planning. She knows what she wants. She likes the idea of primarily curative care to age 75 and then a comfort and functionality care focus after age 75. She does not want to be an ICU. She does not want to be bedridden. My older sister (as it traditionally is the case) is the healthcare proxy in case my dad is unable to assist and I’m the back-up to the back-up.
My dad is still trying to figure out how to have this conversation and what he wants. I’ll ask again at the end of the year or the next time they are on the East Coast grandkid visiting tour.
I need to figure out what I want and have that conversation with my wife.
So have that conversation. Have that conversation if you are young and healthy. Have that conversation if you are old and planning a six month hike along the Appalachian Trail. Have that conversation if you are seeing a doc a week. Have that conversation and then ask your loved ones to have their conversation about what they wish with you.
Balloon-Juice remembers valued commenter greennotGreen and thanks her, her sister, niece, and family for sharing her journey with us.