Being a critical care nurse, I’ve witnessed quite a few people pass away.  I’ve assisted in taking people off of the ventilator to allow them to pass naturally.  I’ve cared for patients that are donating their organs.  I’ve been there for people when they take their last breath because their loved ones could not bear to watch.  I’ve watched the monitor flatline.  I’ve carefully removed wedding bands and given them to crying spouses.  And I’ve gently cleaned patients after they’ve passed and sent them off to the funeral home to await their last goodbye.

I don’t know why, but it doesn’t really phase me too often anymore.  Sadly enough, I guess I’m used to it.

But there’s one thing I just can’t get used to:  people that have never talked about death with their families and loved ones.

Death is a part of life.  It is never if you die, it is when you die.  We will all have this experience.  No exceptions.  Even those people in your life that are so important you, the ones you could never live without.. they’re going to die someday whether you acknowledge it or not.

Once I talked about this with someone that was close to her dad.  She said, “My dad isn’t going to die.  I wouldn’t be able to live without him.  That’s not something to even consider or talk about.”

She said this, as if she had a choice in the matter.  The fact is, her father will die one day whether it’s in a car accident tomorrow or drifting slowly to sleep when he’s 96.  Regardless of when, pretending that it is never going to happen is going to make it all the more traumatic when it does.

So why don’t we talk about it?  Why do so many families/loved ones come into the hospital, never having spoken about death.. ever?

I honestly don’t know the answer to that. Maybe that “I’m invincible” thing you naturally develop in your teenage years never went away.  Maybe no one close to you has died before and you’ve never been forced to deal with it.  Maybe you’re so caught up in your day-to-day that you’ve never had to think about the finality of life.  Or maybe it brings up emotions and you just can’t go there.

I don’t know.  However, regardless of the reason for not talking about this, there is one thing I do know:  the absolute worst time to talk about this for the first time is when you’re standing at the end of a hospital bed, looking at your dad on a ventilator after a massive heart attack with four vasoactive drips, barely maintaining his blood pressure, with his ribs cracked from multiple rounds of CPR.

That’s traumatic.  That’s really, really hard.

And it gets worse.  Now you have to make a decision for him (not for you, for him), never having talked about it before.

That’s even more traumatic.

Because we don’t talk about this stuff when we’re healthy, we’re forced to make the hardest decisions of our lives in the midst of the most terrifying nightmare we could ever imagine.

Many people do not get to pass peacefully because they had not talked about this with their loved ones.   Some people go to the trouble of advanced directives and living wills but don’t share it with their loved ones so they don’t truly understand or appreciate the importance.  Or even worse, they designate someone who cannot see through their own personal desires and pain to make the right decision.

I implore you, as health care professionals and as people that will die one day.. have this conversation with your loved ones.

Identify someone you trust (and it’s not always your spouse!) and talk to them.  Talk to them about what you would want if the decision was either to pass away or to live out the rest of your days in a nursing home, requiring 24-hour care.  Make sure they will be able to see past their personal pain and make the right decision for you.  Make sure they know you specifically chose them to advocate for you.  If you don’t think your legal next of kin will agree with this, it is absolutely essential that you get health care power of attorney paperwork completed.

I argue that this conversation and this trusting relationship is much more important than a legal notarized document with your signature on it.

WebMD explains this in much greater detail here.

Wikihow explains how to go about doing this here. 

Have these crucial conversations now, not in the middle of the night after you’ve been up for 36 hours, staring at your wife who just had a massive stroke with no brain stem reflexes and is on a ventilator.

Do it now.  When you’re sitting down for coffee in the morning, thinking about how much you love her.

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