End of Life Decisions – “When the Rubber Hits the Road”

 

Yesterday morning, before my usual third Thursday meetings with other probate lawyers at the Colorado Bar Association, I attended a very informative discussion put on by Norv Brasch at Bryan Cave HRO entitled  “Estate Your Intentions: A Special Forum on End of Life Issues.”  It was an at-capacity crowd of hospice workers, health professionals, chaplains, other interested people and yes – a few lawyers. . .  Without going into much detail about the litigation that set the stage for the  initial case study discussion – let’s just say it’s themed along the same lines as Trygve Bauge’s frozen grandfather, the subject of Nederland’s “Frozen Dead Guy Days” festival and there was no shortage of morbid humor (mostly in the form of puns).

The broader and challenging issues are about the constellation of decision making and the alignment of actions by a diverse group of people to make end of life wishes “stick.”  When I talk to people about end of life issues, it is typically in the context of an estate plan, but it may also be in a more particular context of crisis planning.  Most people have heard of a “living will,” its technical term is “advance directive,” but it seems fewer people are familiar with the MDPOA – the medical durable (or health care) power of attorney.  The two documents are very different.  The advance directive has had much more press, having been the subject of several U.S. Supreme Court cases, the latest being the case of Terri Schiavo.

I have previously blogged about  the documents important for the terminally ill and everyone else.  The most important distinction to remember is that the MDPOA names a PERSON to make decisions for you if you are unable, while an advance directive is a document that comes into play in very limited circumstances and is a STATEMENT of wishes.  This is not to minimize the importance of having an advance directive, but rather to highlight the need for all of us who are able to

(1) name a health care agent of your choosing and

(2) have a conversation with that person about what you want them to do.

No one wants to accept a job, particularly one that may involve life-or-death decision making – without receiving some instructions first!  What does the failure to plan or name a health care agent result in? We don’t know until it happens, but it is typically decision by a hastily convened committee, often of people with diverse and conflicting interests.  It is not a happy time for anyone involved, and the failure to have the conversation and to make any plans only serve to complicate matters.

The panelists spoke about the challenges of having the difficult conversations about health care and the end of life.  Of course, none of us knows what the end of our life looks like, the where or when or how.  This difficult conversation that so many of us are reluctant to have often gets played out within the hospital setting when a frail elderly loved one breaks a hip or contracts pneumonia.  These seemingly run of the mill injuries and illnesses for the younger folks are still the primary causes of death in the elderly, so this serves to bring front and center mortality for the majority of us: advanced age.  All of our medical technology cannot save us from the inevitable – but what does the inevitable look like?  When do we accept that someone is dying?  Just because we don’t have hard and fast answers to those questions doesn’t mean we shouldn’t talk about them.  One of the panelists commented that “the last place you should be talking about end of life decisions is in your lawyer’s office. . . ” I heartily disagree.  I think having the conversation in your lawyer’s office is a perfect place and time to start the conversation – it is often while it is a more “theoretical” proposition and therefore less threatening. It is different when your lawyer talks to you about disability and death as distinguished from when you visit your doctor.  I have spoken to people about hospice and made the suggestion to consider it more carefully with persons in fragile health.  Is this something most estate and elder lawyers do? I doubt it! Is it part of what is the process of planning (with legal documents) for the inevitable? Absolutely!

The upshot from this great program is that people – everyone – need to talk to each other, to have the difficult conversations!  It is not just about getting the legal documents, medical documents and statements of your desires (which most people do not have). I can say that from my perspective as an attorney and as a mediator, it is about getting people involved with your decision making and making your wishes known so that there will be much less opportunity for guilt, conflict and recrimination among loved ones and family members.

Thanksgiving is an excellent time to remember to consider and say Dr. Byock’s four things

please forgive me

I forgive you

thank you

I love you

and maybe even have the conversation about final wishes.  It’s a holiday about gratitude after all, what more is there to be grateful for than our life?

©Barbara Cashman     www.DenverElderLaw.org

On Grief and Food: Why Feeding Your Hunger Heals Your Heart

This is a guest post by Michele Morris, a local food aficionado and food blogger I know.

I recently attended the funeral of a dear friend – she was young, only 60, taken much too early by a rare form of cancer. I was asked to speak at the service on behalf of a small group of women who traveled together each year, and although I held myself together for that short tribute to her, I nearly collapsed from grief watching her parents pass her casket on the way out of the service.

After pulling myself together in the bathroom with some others (I felt I needed to be the strong one – although I had lost a friend, my good friend had lost her beloved sister, and her parents had lost a child), I went to join the others in the church for a reception. In the south, the “church ladies” pull together food for funerals, and as you might guess, this was a veritable smorgasbord of comfort foods: fried chicken, biscuits and gravy, mashed potatoes with heavy cream and butter, ribs, and dessert – well don’t even get me started about the pastries!

For a moment I thought I was going to be sick staring at the long tables of steaming food lined up, but then I found myself in line along with every other grieving person at the funeral. In fact, I lined up not once, but definitely went back for seconds and possibly even thirds. What is it about grief that inspires us to cook for each other and how is it that when we feel most crushed that we find a way to eat?

At its very core, cooking for someone is a way to nurture them. As babies, unable to feed ourselves, we are fed by our mothers. As children growing up we are fed by friends and family. And as adults, we feed ourselves along with our own friends and families. If someone has a surgery, we make them food. If a new baby arrives, we bring the family a casserole. When we celebrate our kids’ sporting events, we assign roles for snacks. Feeding someone is a way of meeting one of the most basic of human needs. For the person in grief who is being fed, it offers comfort. When you hurt and someone takes care of you, you feel loved, you feel protected, and you feel cared for.

When life is normal, most of us are able to provide this care for ourselves – we can feed ourselves and our families without the help of those around us. But during a time of grief, it’s a huge relief – and a gift also – to have someone else take on this role for us. It allows us the opportunity to just grieve, knowing we’ll be cared for.

As for the foods that are prepared, is it any surprise that comfort foods often top the list? That’s because they are exactly that: comfort foods. They comfort because they are familiar and they often remind us of our childhoods. But that’s not their only trait. Many times they are foods that actually help the brain release endorphins. You aren’t just weak in willpower when you sit down and can’t stop snacking on a bag of potato chips. Carbohydrates (which include sugar), fat and a compound found in chocolate all stimulate the release of endorphins, which trigger a pleasure response. While you may not feel downright joyous at a funeral when you eat those mashed potatoes loaded with butter, you probably do feel just a little bit better.

So for all of you “church ladies” and other friends who have brought food to families in crisis or cooked for the mourners at a funeral, thanks for taking care of people when they most needed it. Your caring – and your cooking – absolutely does make a difference.

Michele Morris is the owner of Cooking with Michele, providing private cooking classes, food and wine dinners, and small event catering. She is the author of both a food blog and a travel blog (cookingwithmichele.com) and has written for numerous regional publications. Her first cookbook will be released in the spring of 2013 and on any given day she can usually be found cooking for someone.  You can email her at michele@cookingwithmichele.com  and find her blog with lots more great recipes at her website. www.cookingwithmichele.com

Did all those comfort food references leave you with a hankering for those potatoes pictured above? Check out Michele’s recipe below:

Buttermilk Smashed Potatoes with Garlic Chives  

Serves 4

 1 to 1 1/4 pounds Yukon Gold potatoes

1/2 cup low-fat buttermilk (or cream or half and half)

4 tablespoons butter

2 tablespoons minced garlic (or regular) chives

Salt and pepper, to taste

 Clean the potatoes under cold water then cut into 1 inch cubes. Add to a pot of cold water and bring to a boil. Cook until potatoes are tender, about 15 minutes. Carefully drain. Return cooked potatoes to the pot and add buttermilk and butter and use a potato masher to smash them together, combining the buttermilk and butter as you do so. Stir in the chives and season with salt and pepper to taste.

 Note:  I like to keep the skin on the potatoes because it’s filled with vitamins and adds fiber to your food which is good for you, but if you don’t like it, you can peel your potatoes first.