End Notes
We Need to Talk
A doctor’s story illustrates the importance of discussing end-of-life wishes.
By J. Lynn Price, M.D.
My father died a little over a year ago. He was 83 and had hypertension and occasional atrial fibrillation. His INR was normal, but he had a spontaneous cerebral hemorrhage that rendered him mostly obtunded and only occasionally responsive. He had been in the ICU for three days when I explained to my mother what was probably to come: a feeding tube, long-term care, and rehabilitation. The idea that he wouldn’t come back around hadn’t yet become real to us.
The next day, the ICU nurse casually said that the doctor had ordered a feeding tube. My mom and I looked at each other, and I could see the panic in her eyes. I told the nurse to please wait. “We need to talk first.” Had we not been in the room, the tube would have been placed.
I was surprised that there had been no “death talk.” Wasn’t taking measures such as inserting a feeding tube something that should be discussed first? We told the nurse we might be considering hospice instead. When the rehabilitation doctor came in and told us they were getting things lined up, we told him the same thing: that we might be considering hospice. We can’t plan how we’ll die, but we all know what we don’t want to happen—and this was it.
Many people wouldn’t have known what that feeding tube meant. So we were ahead of most families in that arena—my dad was a family doctor as are two of his children. You could tell the nurses were relieved to have a family on top of things. But nevertheless, we needed to have that death talk. Making the decision to pull a feeding tube later would have been that much harder.
When a family is in shock, the medical community can aid in their processing of the situation just by having “the talk.” This needs to involve more than establishing the code status—my father was already DNR. It needs to involve talking about options and what the patient would want at the end.
We need to protect the dying in the same way we do the living. We need to ensure that everyone’s final wishes regarding their medical care are known and honored. Just as we mandate seatbelt use and other safety measures, we ought to mandate that hospitals have a discussion with family members before life-saving measures such as placing feeding tubes are taken or transfers to rehabilitation units take place.
The morning after the nurse told us about the feeding tube, my brother found my dad’s living will. We didn’t need it to know what to do, but having it lifted an incredible burden from my mother. It was a gift to us from him. We did what our father wanted, and he died seven days later. MM
J. Lynn Price, M.D., is a family physician at the Fairview Blaine Clinic. Her father, James G. Price, M.D., was a family physician in Colorado for 26 years. He served as president of the American Academy of Family Physicians and the American Board of Family Practice and was dean of the University of Kansas Medical School.