The Conversation

I know this is a difficult conversation for you. It is hard for me too. While I was walking down the hall to this room, I was secretly hoping for a miracle, a sign that we had made a mistake and everything was going to be okay.

I have been taking care of your loved one for a while now. We have used every tool we have available to heal him. Unfortunately, it does not appear that he will ever be the person he was before. No, he is not going to wake up and be okay. I understand you believe this is all in God’s hands, but it is time to make some decisions about where to go from here.

His body cannot survive without the machines that are supporting him. I know he has made some progress. His blood pressure and heart rate are normal. However, he is now dependent on dialysis because his kidneys have stopped functioning. He is not going to be able to breathe without the ventilator.

Where do we go from here?

Have you ever had the discussion with him about his wishes?

There is are no further medical interventions left to try. This is the new reality. There are few resources available for people in this condition. What quality of life can one expect in this condition?

I know you had hoped for a different result. Yes, he is a fighter.

This conversation never gets easier. It always hurts and I always wish I could be anywhere else. I often wonder how I would feel if it were my family member, and I try to remember the fear I would feel. I try to imagine what my concerns would be.

I do everything in my power to be able to answer the questions the family has. I make sure I have time to listen. I make sure I am completely honest. I try to keep my personal feelings out of the conversation. This is about this patient. Sometimes acknowledging the reality of the situation is the most important act I can do.

The conversation about goals of care is difficult for many healthcare providers. For some of us, especially early in our careers, it can feel like a personal failure when our patients do not survive. The crux of the situation is that everyone will die someday. Perhaps the best thing we can do is offer dignity and peace when death is looming. Comfort measures does not mean giving up. Dying is a natural part of life. We should feel lucky we have the tools to help ease suffering.