Ihavefollowedherinthemonthsandyearssince,asshe
embarkedonchemotherapy.Shehasdonewell.Sofar,
thecancerisincheck.Once,Iaskedherandherhusband
about our initial conversations. They didn’tremember
them very fondly. “That one phrase that you
used—‘prolongyourlife’—itjust...”Shedidn’twantto
sound critical.
“It was kind of blunt,” her husband said.
“Itsoundedharsh,”sheechoed.ShefeltasifI’ddropped
her off a cliff.
IspoketoSusanBlock,apalliativecarespecialistatmy
hospital who has had thousands of these difficult
conversationsand isa nationallyrecognizedpioneerin
trainingdoctorsandothersinmanagingend-of-lifeissues
with patients and their families. “You have to
understand,” Block told me. “A family meeting is a
procedure,anditrequiresnolessskillthanperformingan
operation.”
One basicmistake isconceptual. To most doctors,the
primarypurposeofadiscussionaboutterminalillnessis
to determine what people want—whether they want
chemoornot,whethertheywanttoberesuscitatedornot,
whethertheywanthospiceornot.Wefocusonlayingout
the facts and the options. But that’s a mistake, Block said.
“Alargepartofthetaskishelpingpeoplenegotiatethe
overwhelming anxiety—anxiety about death, anxiety
aboutsuffering,anxietyaboutlovedones,anxietyabout
finances,” sheexplained.“There aremanyworries and
realterrors.”Nooneconversationcanaddressthemall.
Arrivingatanacceptanceofone’smortalityandaclear