Chaplain's Corner

Over the years that I have been working as a health care chaplain I have had the privilege of serving many families that faced a terminal diagnosis of a family member. There are many different reactions to such diagnoses but almost universally there is sadness.

In our region we have Palliative Care services available to those who receive this kind of news when the death is expected in six months or less. One reality that I have observed is the hesitance of some doctors to refer their patents to palliative care services. I have wondered why.

It may be that not all our physicians are fully aware of the palliative care services that are available. We often assume that our doctors know everything about the medical system they work in. This is an unreasonable expectation. Others may hesitate because they don’t feel the person they are caring for is ready to face that reality. Or there are some physicians who are uncomfortable talking about death. This really shouldn’t surprise us through, after all, doctors go into medicine to heal, to cure, to care for patients and get them back on their feet. However we know that ultimately, every patient will die.

Many doctors have not yet become comfortable with their own mortality, consequently they struggle with the mortality of their patients. Other doctors hate to lose and feel that changing the treatment plan from curative to palliative is an admission of defeat. Some feel that they would take their patients “hope” away by being frank about a palliative prognosis.

However, the reality is that the best course of action for a physician who knows that his or her patient has turned the corner and that the prognosis in terminal is to begin talking about this reality as soon as possible. Some patients will respond with denial. Denial is a defense built into the human psyche that protects us from things we are not yet prepared to face. When a palliative prognosis is met with denial, the patient isn’t being difficult, the patient has simply begun the process of embracing reality. The doctor’s honesty triggers the process many times.

At times the supporting family will accuse the doctor of “giving up”. Doctors would be wise to simply absorb those “accusations” for they are desperate attempts to push an unwanted reality away. Reality will settle in soon enough and the doctor that can absorb the anger and be present for the patient and family through their period of denial, will have the privilege of caring for them throughout the remaining days of their life or transitioning them to the care of a palliative care team that can insure that symptom control is optimized and that the supports available to the family and palliative patient are in place.

I’ve mentioned the book before but I recommend it wholeheartedly to any family who finds themselves facing the terminal illness of a loved one. In Final Journey Maggie Callanan provides a very practical, extremely readable description of the issues and care that palliative patients and their family supports face. It is full of real life experiences from her journeys with over 2000 families.

Doctors and nurses, homecare workers would all benefit from reading the book. But it is particularly written for families who are forced into taking the final journey with a loved one that has been diagnosed with a terminal condition. Final Journey is not a dark, gloomy, depressing book. Far from it, it is full of light and hope and joy for it demonstrates that the “final journey” of a person’s life need not be taken alone, without support and overwhelmed with anxiety. With palliative care support, the journey can be eased, good days can be extended, and the final days of life can be managed in a way that everyone is spared the anguish of a “bad death”.