Communication

I actually have a nice, juicy, post on palliative sedation I've been working on, but I keep getting bogged down and distracted by things like, work, and writing my first chapter. In the mean time, I'm trying to get better at the short pithy posts.

Recent conversation during a "toxicity check" (assessment of patients ability to continue to receive chemotherapy):

NP: "If something should happen and you were unable to make your own decisions, who would you want to speak for you?"

Patient: "My wife."

NP: "And she knows what you would want? What kind of decisions you would make?"

Patient: "Oh yeah."

Patient's wife: "Oh no I don't!"*

Unfortunately, this is more the norm than the exception. I remember at the annual hospice conference last year there was a presentation of study that involved health care proxies, and the majority of the participants didn't even know they'd been named as the medical durable power of attorney until their loved one was incapacitated and they were being asked to make decisions! (apologies for not being able to cite the study or the presentation, all I can remember is that it was presented by R. Sean Morrison -- if anyone knows the study I'm talking about, please let me know!)

Think of this as a wake-up call: if you have strong thoughts about what kind of care you'd want in a life-threatening situation (and if you don't, you should start thinking about it), talk to the people people who would be making decisions for you if you can't speak for yourself. You owe it to yourself, and to them.

*I can't help but wonder if this sparked a conversation between them about this. I sure hope it did, but I'm not confident that's the case. As it wasn't my visit (I was observing E.) I didn't pursue it.