“My wallpaper and I are fighting a duel to the death. One or the other of us has to go,” says Irish author Oscar Wilde on his death bed, according to legend.
Though room decorations may not be a concern for some during their last days, people’s wishes for all aspects of the final journey can be better respected if planning starts early, a Vanderhoof physician said.
This year, Vanderhoof’s doctors look to focus on advance care planning for the final stage of life — starting with an interactive group presentation at the Omineca Medical Clinic on March 2.
“In so many times, [the conversation] happened at crisis, ‘Now you’re really sick, what would you like, what’s important to you, what would you not like us to do,’” said Dr. Nicole Ebert. “That’s a really awful time to ask a family or patients what their wishes would be.”
The discussion is more than the traditional dialogue on medical technicalities, such as “being hooked up to a machine or not,” Ebert explained.
“We’ve made the dying process medical,” she said. “As opposed to what’s important to you, what are your values and goals, how do you see yourself at the end of life, how would you like the end of life to be.”
The switched focus would allow doctors to choose appropriate medical procedures to match the identified personal values, she added.
“As opposed to having [patients] pick a medical procedure, which isn’t really fair, because unless you’ve seen it, you don’t know what it really is, or if it’s going to help,” Ebert said.
An earlier conversation will not only decrease stress, but also the conflict that may arise between family members, she added.
“It’s amazing how much guilt there is,” Ebert said. “All of a sudden a family member has a stroke and can’t tell you what they want, and nobody knows.
“We’ve seen people living longer and we can do more things at the end of life, so now we’re trying to figure how can we help people through that stage of life…’cause it’s going to happen, the one sure thing.”
Currently, doctors introduce the discussion when their patients have many complex, chronic diseases — conditions that will likely shorten their life or affect how they die — but they look to expand the conversation to the population who don’t, Ebert explained.
“‘Cause you never know what’s going to happen…you see that too often, and you read about it all the time now,” she said. “Sixty is not too young to think about what’s important.”
Death, seemingly too far on the horizon for those feeling healthy, may be a difficult subject for many people, but this is the time to make plans, Ebert said.
“It’s hard to have the conversation with people in their 60s, when they are completely functional; they’re working and they’re like, ‘Why do I want to think about this,’” she said. “Because you are well and you know what’s important, you have time to think about it.
“I have quite a few patients who said they don’t want to talk about it right now, or they’re just not sure.”
As many years can pass before the recorded ideas for that final stage are needed, plans can certainly change and be edited as time goes on, Ebert said.
“This is an evolving thing because what you can see yourself as important for you in your 60s, may be very different from what you think in your 80s,” she said. “So the conversation keeps getting revisited.
“Your plans can change.”
In addition to the last threshold, the advance care plan may also include earlier implications such as housing, she said.
“‘Where do I want to live at that stage of my life — can I live in my home until the end — or do I need to think about, at some point, I may have to move i.e. there’s too many stairs in my house, if I have support around town, has everybody moved away,” Ebert added.
For Julie Ephrom, a registered nurse in Vanderhoof for 36 years, a living will — also known as an advanced directive — outlining her wishes for the final stage in life was created in 1993.
In the 1990s, she was not only involved with sustaining life and dying through her work, but was also the coordinator of the Vanderhoof Palliative Care Society — now called Vanderhoof Hospice Society — where volunteers were trained to accompany people during the end of life, Ephrom explained.
“In that role what I saw was that very often people haven’t had [that] conversation,” she said. “We started looking at what can we do for people to better communicate their wishes before the event.”
Even if the wishes were discussed, there was no written record.
“You can have a conversation with somebody, then six months later, an event happens, and everybody’s like what did they say,” Ephrom said. “This gives them something to go by.”
For some of her family members who have passed away, living wills that were made months ahead to outline their wishes proved useful during the final moment in the hospital, she recalled.
“It reassures the medical system, it reassures your family, or yourself only,” Ephrom said. “We go through life expecting we’re going to get a hamburger, we go to the movies with our friend.
“We don’t go through life expecting you’ll get whacked at the intersection.”
She added, “It was important to me that I’m self-directed in life; why wouldn’t I be self-directed in death.”
The interactive group presentation on advance care planning will take place on March 2 from 5:30 p.m. to 6:30 p.m. Interested participants are advised to contact the Omineca Medical Clinic to allow adequate space for the event.
This is part one of the Omineca Express’ article series on advance care planning, with more to come in future editions.