Like taxes and traffic jams, death is a situation that we all have to deal with in our lifetime. How and when death may touch our lives is something we can only guess. The ways in which people deal with death vary. Given the uncertainty, one way to bring ease to the situation is to talk to those closest to us about end-of-life wishes. This will enable us to deal with the transition in a less stressful manner.

As a nurse, I have the unique position of being a part of the dying experience. To me, it is just as special a moment as birth. Through my experiences with helping patients and their family members deal with death and dying, I have learned about certain things everyone should be aware of to ease this often distressing situation. Two patients come to mind.

Margaret was an older lady whose husband died a few months before she left to visit her daughter in Arkansas. She lived in the Virgin Islands, where a few of her adult children also lived. While visiting her daughter, she had a massive stroke and was admitted to the local hospital. Eventually, she was transferred to the hospital in St. Thomas near her home, where she was a patient in the ICU for an extended period. She had six adult children scattered between the States and the VI.

Margaret’s condition was grim. She was unable to communicate other than occasional facial expressions. She was unable to breathe on her own and needed a mechanical ventilator. She was also being fed through a tube to her stomach. She required 24-hour nursing care. The children close to her didn’t want to see her continue by artificial means; however, her children who hadn’t seen her didn’t want to let her go. Long story short, Margaret didn’t have an advance directive. Because  legally it fell on her children, equally, to make decisions about her care, she ended up living this way for several more months.

Denny was an older gentleman with adult children who had recently married a lady quite a few years younger. He suffered a massive heart attack and underwent bypass surgery from which he never fully recovered. His condition was such that he depended on 24-hour intensive nursing care, requiring many tests and treatments, despite the fact that his prognosis was grim and his condition wasn’t reversible. His young wife, idealistic and hopeful in her outlook, wanted everything possible done. His adult children, however, knew Denny wouldn’t want such extreme measures. Since his wife was the legal next of kin, decision-making fell on her shoulders. Tension grew between the wife and the children. A few months later Denny passed away in the ICU. Had Denny documented his end-of-life preferences, treatment decisions could have been made based on his wishes. A lot of suffering and tension could have avoided.

It all starts with a conversation!

First and foremost, we all need to talk to our loved ones about our values and feelings concerning death and dying. It’s not easy. The very word “death” conjures up a myriad of emotions. The best way to make sense of these emotions and become more comfortable with the inevitable is to talk about them. One thing that you may want to focus your conversation on is what you value most in life. What does quality of life mean to you?

Once you have discussed this with loved ones, the next step is to talk to your health care provider. When speaking to a health professional, you may inquire about different medical treatments used to prolong life and treat any chronic illnesses you may have or that run in your family. At the same time, you may want to ask what alternatives there are to heroic, life-extending measures, such as comfort care and pain management.

Some treatments used to prolong life include:

• Dialysis: filtration of the blood when the kidneys are not functioning properly.

• Artificial nutrition: nutrition delivered to your body through a tube to your stomach or through an IV to your veins.

• Mechanical ventilation: breathing assisted by a machine when the lungs are not working adequately.

• CPR: chest compressions and resuscitation when the heart is not pumping adequately to sustain life.

These are just a few of the many medical treatments that may be called for in an end-of-life situation; some of them can be temporary depending on the situation. These may never be something that you or someone close to you need, but it is worthwhile to be familiar with these treatments and terms. Things happen unexpectedly, and sometimes treatment decisions need to be made in haste; familiarizing yourself with these terms may help.

It is important to remember it is perfectly normal not to want any extraordinary measures. In fact, many people make this decision for themselves. Some believe that once the body is unable to maintain itself, a natural course of decline should be allowed with comfort being the goal of care.

Along with discussing thoughts about death and dying, it is also important to determine who will make your decisions in the event you are unable to make them for yourself. Keep in mind a few characteristics when determining who will be your durable power of attorney for health care or surrogate decision maker (i.e., someone who can make your decisions if you are unable). This person should be a legal adult who will listen to and advocate for you, even if he or she doesn’t completely agree. Your surrogate decision maker should live close by or have the ability to travel in your time of need.

The final action in this process is putting it in writing in an advance directive, or a living will. There are many resources for completing an advance directive, such as your health care provider, local hospital, and many resources on the Internet. Each state has different laws concerning advance directives, so seek guidance and resources within your state.

Thinking about the end of our own life or that of a loved one is distressing. It’s not something that most want to focus on. However, a few conversations with those closest to us can mean a world of difference in a situation of life and death. There are no guarantees or ways of knowing what the future will hold, but with some frank conversations and clarifying your values and priorities, you can look forward to a peaceful transition. 

Amy Schweizer is a registered nurse and assistant professor of nursing at the University of the Virgin Islands. She has practiced in many different critical care settings geographically and clinically for almost 10 years. She has a BSN from George Mason University and a MSN from VCU.