149: 20.2 Acknowledging death

We had a lecture today about end of life care. One of the many topics we covered included the nomenclature of hard end of life conversations. It was pointed out that sometimes, to nudge the family into understanding what we mean, we often stay away from using the word "dying". Instead we use "deteriorating", "downhill" and "poor prognosis". All these terms lie on a spectrum - one of which your loved ones would always hope for the right end. You see, the word "deteriorating" has its partner in "improving", "downhill" has "uphill" and "poor prognosis" has "better prognosis". When using subjective terms like these, there is a high risk that those who hope for good news will not internalise the message.

One only hears what one wants to hear. So most times, the understanding of a patient or family member would grossly differ from what was being conveyed. But there is no flinching, scapegoating or alternative interpretation of the statement, "He or she is dying." The word "dying" could seem so abrupt but that is what is required to be truthful in order to prepare families and patients for what is imminently coming. By using "dying" there is an urgency - an urgency to tie loose ends, to call family members and to arrange plans. To be kind in this case, one has to be cruel. To lead people from hope to acknowledging reality is hard, but very much necessary.

I have had personal experience through the passing of my own grandfather. I remember that on his last day, the doctors were still telling us that he had a 50/50 chance. Even when the odds dropped to 30% survival, we were still hopeful. We thought 30% was still something - and we held on to that. We held on to that with every strength we could muster. But what hurts most is the knowledge that they all knew - the nurses and doctors -  they were leaving us with rose coloured glasses on, in fear that the truth would be too painful to bear. They gave us false hope. They all knew that he was not going to survive this - but no one was brave enough to tell us. No one mentioned the word "dying". And because we weren't prepared, his death was made even more traumatic.

Given the chance, we could have had the opportunity to say our goodbyes. But unfortunately that opportunity was robbed from us. The trauma from my grandfather's death has subsequently made me motivated to not allow families to go through what I went through. Although I am junior, I still make it a point to have those difficult discussions - one that many have problems having. I am not shy in approaching the subject of death, because I have learnt from experience, that denial and ignorance will lead to more detriment than bliss.

It is strange how that in this life, the only certainty is death. Yet, how little we speak of it.