Three suggestions for an end-of-life story that has dignity and peace

"We are our stories," says author Niall Williams in her novel History of the Rain. "We tell stories to pass the time, to leave the world for a while, or go more deeply into it. We tell them to stay alive or keep alive those who only live now in the telling," There are times I'm in awe of the unique privilege we have, working in healthcare, to be such a significant part of the story of people's lives. We're there when they recite their histories from the day they were born, retelling the stories they heard from their mothers describing how they came into the world. And we're part of the story of at the end of their lives as well. 

I was reminded how important it is to give people a death with dignity and peace not long ago when my wife Mary Carole's mother passed away. It was a good final page for her mortality. She was 91 and had expressed that she was ready to go. She was surrounded by family and able to say goodbye to those she loved. She had set her personal relationships in order, and was at peace with her faith. We were sad to see her go and we miss her, but we were grateful she was able to die enveloped in love and on her terms.

What story do we want to tell, and have told of us as caregivers, when our patients, neighbors, friends, and loved ones share the end of their lives with us? We're fortunate to be offering some of the best end-of-life care available anywhere right here in Utah. Utah is a leader in allowing people to die as comfortably as possible at home instead of in the hospital. We help protect a family's resources by having the nation's lowest number of inpatient days in the last six months of life, and among the highest in hospice care. Intermountain is a big part of that good story. How can we keep improving?

Perhaps the first place to look for answers is by asking ourselves: "How do I want to experience the end of my life?" Most express a preference for spending their final days at home, without pain, surrounded by loved ones. Many lament the idea of ending their lives in a noisy hospital, undergoing painful — and often expensive — treatments that may only buy a few extra days. How can we give our patients the opportunity to make the choice that's right for them? Three things come to mind:

We can help our patients understand their condition and then allow them make informed decisions about how they want to proceed. This isn't always easy, but research indicates clinicians who reveal the truth to their patients in a timely, honest, compassionate manner can actually help them engage constructively with their grief — replacing unrealistic hopes for recovery with a more profound and resilient kind of hope.

Discussions with patients nearing end-of-life should include a realistic conversation about the cost of treatment options. Many end-of-life treatments are extremely expensive. This discussion isn't to diminish their value at the end of their lives, rather it should be a show of respect for their resources, and something that can help inform their decisions. This has a place at every point in the healthcare journey, not just at the end of life.

We should honor each patient's wishes as closely as possible. That means we need to listen to their desires without judgement, and make sure family members and other caregivers understand.