Medical schools today teach doctors and nurses how to talk with patients and their families about dying, but for millions of health care professionals trained in the 20th century, conversations about death are difficult. That’s why the University of Virginia plans its third annual conference on the subject.
Ken White is an associate Dean at UVA’s School of Nursing, but he’s spent many years caring for patients and at a major medical center like UVA, he says, dealing with dying patients and their families can be difficult. For one thing, they come from different religious and cultural backgrounds.
“A typical day might be someone who’s a Muslim faith. The next one might be an atheist, the next one might not be able to speak English. The next one might be in a same sex relationship. How we approach them is dependent on how much we know about and respect where they’re coming from.”
And even in places where people share a common culture and language, doctors may not want to discuss the end of life.
“They want to do everything they can, and when they can’t do anything, they’re frustrated, or they believe that they’ve failed.”
UVA recently surveyed eight critical care units and found nurses didn’t do much better.
“The number one gap in competency among nurses in the critical care units was communicating with patients and families about death and dying. It’s just not talked about in our culture. Nurses don't talk to families well about it, and nurses and doctors don’t talk well to each other about it, particularly in the intensive care units.”
Even patients are reluctant to make important decisions about their final days.
“They just go to the doctor and they give up their rights and their choices, and they say ‘Doc, just do what you think’s best.’”
Often, Ken White says, people wonder what to say. In fact, it may not be necessary to say much, but it’s important for family and friends to be present and focused on the patient. He recalls an older patient – a professional photographer, who had suffered a stroke.
“And they didn’t think that she would wake up, and the husband sat there with her every day, day in and day out, and I said, ‘What’s she like as a person?’ And he said, “She loves piano music – particularly Chopin and Lizt.” And I said, “Let’s get some in here, and when you go home, why don’t you get her photographs, and let’s plaster them all over this room, and do you know she woke up and she went home. The other thing it did was it humanized the person in the bed to the staff. She wasn’t just this woman in a coma. She was this amazing photographer, and I think that does something very special to the spirit.”
And, finally, he tries to offer hope.
“Maybe not for a cure. Hope can be maybe for a peaceful death. Hope can be maybe that you get to see your son one more time, or you get to attend your daughter’s graduation from college, or that you get to have your dog in your room with you.
These and other subjects surrounding death and grief are the focus of a conference set for September 17th at UVA’s nursing school. Health care professionals and the public are invited to register and attend.