My New Practice Part II End of Life Care

Yesterday, I described part of the service (my approach to behavior change) which I provide when people come to see me as a doctor. Today, I would like to explore a very different yet very integral part of my practice. End of life care is a big, black box for so many Americans and it can be scary and quite overwhelming. As everyone seems to have a different path medically, spiritually and emotionally when our time comes, it seems difficult to even talk about this topic. However, in my experience, the more openly we face and discuss the inevitable end of life, the better the process seems to go. In fact, bringing conscious awareness to this phase of life can actually allow the time to be meaningful, fulfilling, and relatively free of the suffering we associate with it. That it is not to say that there is not some struggle and difficulty associated with "leaving the body" and our lives. There always is a major challenge with this time of life but when it is approached with a "holistic" perspective as opposed to a "body-only", medical one where death is the enemy and life is something we cling to, oftentimes, suffering is increased and tremendous opportunities are missed.

In my experience, people who have a spiritual approach to life and death generally tend to fare better when the end of life comes. A belief in an afterlife or re-incarnation tends to allow for continued hope and a more positive approach as one's time on earth nears its end. However, this is not a requirement for making the transition time less medical and more fulfilling. The medical world tends to "medicalize" the end of life focusing on whatever it can do to prolong life and de-emphasize the psychospiritual aspects of the experience. The hospice movement has greatly improved this time for many people bringing comfort to the dying, support to their loved ones and a psychospiritual framework which allows this time to be incorporated into the fullness of a whole life. Indded, we are truly blessed to live in a time where hospice support is all around us.

The problem lies in the transition from life to death when death is not clearly going to ensue in the near future. At this time (especially when there is no life-ending diagnosis), individuals can become lost in the "medical" world without a clear path out. Fear, sadness and suffering often accompany this state as people "battle" their conditions but do not quite know why. It is here that I believe I can be helpful. Openly discussing an individual's situation with or without loved ones can open the closed and scary doors and bring a peace and a plan that provide much more comfort than a quick pharmaceutical or another medical intervention. There is a whole world of care that can be delivered even when a situation is not clear with defined diagnoses. The key to working through these situations is open communication. The earlier these conversations occur, the better. The more open the conversations are, the more love and closeness become available.

When people come to acceptance and comfort in their place, suffering dissolves. Fear of the unknown is often worse than fear of death. Prolonged physical suffering without an envisioned route out is much scarier and disturbing than when the truth is known and options and comfort are accessible. There is so much that can be done for someone even when a disease or condition cannot be cured. Love, support, touch, and compassion go a very long way and when they work in concert with good supportive medical care, everyone does better (patients and their caregivers). We have come a very long way in our capacity to support people in their end of life; opening the conversations beyond the medical is the doorway to a better path.