The Importance of Having End of Life Conversations

Recently, a very frail client I have known for many years entered the hospital with a serious and sudden health crisis. She was 89, had survived cancer, a stroke, and lived with the debilitating results of Parkinson’s Disease for over 15 years. She needed 24-hr care and assistance with everything, but was cognitively sharp most of the time.

Faced with making critical decisions by phone, her daughters who live across the country were relying on me to interface with the medical staff, ask key questions, and most importantly be with their mother since they could not come quickly. Many conversations had occurred previously about her wishes at end of life, but not all scenarios could be anticipated.

So, at a critical point, doctors needed to know whether or not to intubate her since her breathing was becoming compromised. Several times during this short hospital stay the answer to this question had been “no” to any aggressive measures such as intubation or resuscitation, since her daughters wanted her to be kept comfortable.

However, faced with a life or death decision, saying “no” to intubation was no longer clearcut over the phone. Her daughter said “yes” when the MD described her condition. I believe the overwhelming decision she had to make frightened her at that moment. Luckily, after a quick conversation with her sister and myself, realizing she had possibly made a mistake, she was able to put herself in her mother’s position and remember what her mother had told her. In her frail condition, she did not want any painful or aggressive medical interventions. She had lived a long good life and said to let her go when the time came. A swift call back to the MD ensued and thankfully intubation had not occurred yet. Shortly after, my client passed away.

Families who have been open and have conversations about the end of life are far better prepared to make these critical decisions, honoring their loved one’s wishes.

Our medical system is fantastic at treating critical illnesses, however, when it comes to our frail elderly, deciding when not to treat and when to let go takes courage.

If you have not done so yet, I encourage you to start the conversation in your own family, and with clients or patients you are working with.

by Joan Garbow, LCSW, CCM