Sunday, August 31, 2014

The Watch No One Wants and the Discussion

Life requires all of us, whether we want it or not, to make tough decisions. Sometimes it is dealing with matters of finances, family interactions, or whether to have an unpleasant discussion with our neighbors. But the one discussion we don't want and which we will push off as long as possible concerns a particular watch where we are compelled to make truly heartbreaking decisions.  What we decide and when we do it will be forever with us after the fact. The incessant personal questioning whether it was right or not will not settle down for many months, if not years. No matter what comforting is offered or words of wisdom offered, it is still us who made the decision.

Joan Rivers' family and, in particular, her only child, Melissa, may be facing this difficult decision this week. Media reports are saying she is "in denial," but who wouldn't be when your mom is such a dynamic, energetic woman who just finished a comedy engagement the night before? It's unthinkable that there would be something like this facing her after something described as a simple medical procedure.

The watch has many names and it really doesn't matter what euphemism you use, it is, to put it bluntly, a death watch. The family and close friends gather and try to be upbeat either in a hospital room or an apartment where they await the call to "come now." It is that "come now" that strikes the heart like an ice pick that runs through to our backbones and the final moments are upon us. Then it is that we must say that painful last goodbye and we try to be strong for everyone else even as we grieve intensely.

I happened to be in a hospital waiting room for visitors to patients in intensive care when a well-known dancer was brought in. He had organ failure and his friends sat a table trying to be upbeat. They talked about the costumes for the next season, what they were planning for the week ahead--anything but the condition of their friend and mentor.

Reactions can run from the frozen as though surrounded by an invisible caccoon and the voices come from somewhere off in the distance, not from beside us. In others, it will mean a collapse and the feeling that all is lost and happiness will never share our existence as it once did.  Happiness will return but we don't believe it will.

The discussion has always been difficult and whenever a physician wanted to have it, prior to grave illness and impending death, there have been few guidelines and no support from Medicare or insurance companies. A new medical service code is being formulated to permit payment to the physician for having these discussions with their patients. The change has come and insurance companies are encouraging physicians to have patients make their wishes clear prior to any need for a determination of a DNR (do not resuscitate) order or to initiate any heroic medical procedures.

Of course, it's not altruism but cost savings that has prompted it, but that really isn't the central issue here. The discussion needs to occur and it should not be put off. Deftly defining our final wishes saves our loved ones from making the decisions for us at a time when they are emotionally ill-prepared for it. Love is expressed in many ways and this is one of them.

Sooner or later all of us will come to this watch and this decision. Better to have had it years before than then.

http://www.drfarrell.net