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Commentary: Don't waste the final moments

November 29, 2013|By Dr. Allyson Brooks

Seven weeks before he died, my father gathered my mother and us four children for a conversation at his home.

His battle with multiple myeloma was clearly being lost. Compression fractures in his spine had shrunk his 6-foot-1 frame to 5-foot-8. He had lost 40 pounds and the use of one eye. He was diagnosed with dementia and was in constant pain.

Still, the former attorney was sharp as a whip as he held court in his living room. He wasn't ready to die. He didn't want to die. But he knew he was dying – and since he was dying, he wanted to do it on his terms.

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I am an obstetrician, devoted to bringing people into this world. Oh, the magic and beauty of birth. Until my father's journey through hospice, I hadn't realized that death can be sacred and spectacular too.

Not everyone has a say in his or her final days, of course. Accidents, murder, heart attacks – these can all claim a person's life in an instant. But many, like my father, die after a long battle with disease. We see ourselves deteriorate and have the time to ask: Do we spend our final weeks in and out of doctors' offices, or do we savor the time we have left?

At our meeting, I printed out some information about hospice care. I got the idea from a patient of mine, a clinical care social worker. She regularly sees families in the ER who have never talked about their wishes and are left bewildered and anxious at the end.

"Hospice," she told me, "should become a household word."

So I introduced it to my household, and at first everyone seemed incredibly interested in their shoes. Eventually we began talking: One sibling wondered if we were being fatalistic. Another asked if the pain medication would hasten dad's death rather than support him through it.

In the course of two hours, we asked dad, point by point, about his preferences regarding everything from feeding tubes to resuscitation. Everyone had a chance to hear what he wanted, get clarification and ask questions.

Then we had lunch.

A few of us laughed: "We just had this intense two-hour conversation, and now we're pretending that everything is normal."

"We're not pretending," he said. "It is normal."

Dad was right about that — as he has been about so many things. Planning is normal. All day, I talk to expectant mothers about their plans for the start of life. For my father and for our family, it was meaningful to plan for the end too.

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