living your best to the end
End of life decisions and next Tuesday’s food.

End of life decisions and next Tuesday’s food.

Dr Rebecca Sudore: changing focus from planning end of life to preparing for end of life decisions An Associate Professor In-Residence in the Division of Geriatrics at University of San Francisco, the impossibly young Dr Sudore is dedicated to helping vulnerable older adults and their families make informed medical decisions, especially for advance care planning and at the end-of-life Dr Sudore, at a University of Toronto Bioethics Speakers series, used this question to illustrate the impossibility of meaningful planning for life’s end: ‘Do you know what you’re going to eat next Tuesday? The answer: ‘it depends’. And so it is in planning for what’s essentially the unknowable in the end of life journey. Dr Sudore’s research and objective instead is: prepare for decision-making. Seemingly simple questions, says she, open the floodgates. Is there anyone you’d trust to make medical decisions? Do they know? What have you talked about with them? 50%-76% will be unable to make our own end of life medical decisions The importance of conversations with the surrogate can’t be emphasized enough. Even so,having spoken to dozens of surrogates as part of her research, the findings are distressing and revealing: Many surrogates don’t want the role. Sudore thinks it of paramount importance to ask the question of patients: Are you ok with your surrogate making ‘in the minute’ decisions? Giving your surrogate permission to override or change your wishes – putting flexibility or leeway right into your Advance Directives – can make the difference between a surrogate adjusting to loss or suffering from Post Traumatic Stress Disorder. Dr Sudore gives, as an example, this discussion with her...
Rodger Harding: my parents’ good deaths made me less fearful

Rodger Harding: my parents’ good deaths made me less fearful

“They both died young, but they’d accepted death” Rodger Harding’s mom died of colon cancer, his father 3 years later of emphysema. “They both died young – 61 and 69 –  but because they’d both accepted that they were dying, it took away the terror – for them and for me. This is not to say it dying was an easy or pretty process to watch.  But it still took away that fear.” Rodger knew something was up several months before his mother was diagnosed  “She wasn’t able to eat at the lavish lunches that were a monthly tradition with us. “ It wasn’t until the second operation that she understood: “She said to the doctor, ‘You’ve opened me twice. Did you take it out?’  When she heard the answer, her attitude was: ‘I’m facing it, we can have a good cry. I don’t mind dying but don’t really want to say goodbye.’ Friends would try to persuade her that she would get better. She wanted none of this.” Rodger, his brother and his father rallied. “We took her to the sea and wherever she wanted. She was feted, loved, made to feel special and pampered by all the people she’d ‘touched’ in her life. It was like a party. His mother, who loved food, would eat and enjoy it, and then throw it up. “She had to eat veggies, so I made her the only veggie dish I knew: ratatouille. Her sense of  humour kicked in, ‘I’m dying, and have to have ratatouille every day?’ When she became weaker, and had to go back into the hospital she...

Dignity Therapy at Life’s End: Thank you Dr Harvey Chochinov

Dignity Conserving Care asks at life’s end: ‘What do I need to know about you as a person to give you the best care possible?’ To give an answer as a person, rather than as a health condition is a focus-changer for providers and for patients alike. As a patient – albeit feeling my healthiest –  I wouldn’t be able to answer that question without some serious soul searching.  However,  thinking about this, when depression dropped its darkness on me, I told my GP of almost three decades: ‘I so hate not feeling energetic or optimistic’. I could do that because she’s come to know me as a person. But at life’s end, will she be there with her specific knowledge of what makes me, me? My family knows me both energetic and optimistic, and fatigued and depressed. But I’ve not told my family it’s one of my worries at life’s end – oxymoron tho this may be – I don’t want to die depressed. I am aiming for a joyful departure. I feel more confident in this, knowing about Dignity Therapy: Thank you to Winnipeg’s Dr Harvey Max Chochinov  – a psychiatrist who has been forever interested in how people cope with and manage chronic debilitating and often terminal illness: Dr Harvey Chochino Dr Harvey Chochinov: “My older sister was born with and lived with Cerebral Palsy, so I was a brother who grew up knowing something about chronic life altering conditions.” Moving forward in his career, studying at Cornell, Chochinov found that in his day to day working largely with cancer patients… “what patients encountered coping with chronic, deteriorating...