July 15th, 2020
The most important thing people need to know is that even death in a hospital has many different possibilities. Even though many of those deaths are medicalized and happen in a situation of receiving very acute care, which involves lines and tubes and sometimes discomfort, it doesn't have to be that way. Even within a hospital, one can have the kind of death they would wish for. It can certainly involve palliative care and hospice. It can also include the type of surroundings that are important, like music. All of those things are available in a hospital setting.
The most important thing is to be as explicit with yourself as possible about what you want before you're in the situation. And that's a hard conversation to even have with yourself.
We tend to romanticize dying at home. I have a lot of patients actually look at that option, but the idea of leaving those memories for their family in their house can take on a different weight when it's not abstract, but when it's an actual fact that is going to happen. It comes with a lot of emotional currency that you're drawing off your family, so it's important to be honest about the practicalities of our choices, honest about who it's impacting, and whether they have the capacity for it, whether they have the emotional bandwidth. These are all acts of love that we can still do while we're alive.
When we think about what we want our death to look like, it helps to think less about place and more about situation. What are we actually hoping to be surrounded by? Are we talking about being at home because we want familiar things or is it because we want to be in a comfortable bed? Is it because we don't want doctors and nurses around?
Really get granular with yourself about what that looks like. That's the first part so that you can communicate to the people who will be your advocates.
July 15th, 2020
When I hear that question, I'm inclined to scream, "Don't do it!" But, that's not really fair and is obviously my bias. Just make sure you understand it.
As wonderful as most healthcare teams are, the topic of dying is a difficult one. Some people don't feel comfortable having needed conversations, so the only way you can get the answers you want is to be direct.
If you're considering dying in a hospital, it's important for you to make sure you understand what that entails, how that could play out. Ask your healthcare team this exact question in as direct a manner as possible. I would ask as many members, separately, as possible because you're bound to get different perspectives. They're all true, but they're all different lenses.
You'll want to understand the totality of the experience, so I would say to ask as many questions as you can. Be blunt, direct and clear about what you're asking. They are looking to accommodate you as they want to make the situation as palatable for you as possible.
You're helping them by sharing what you want in your environment and how you want that experience to transpire. Tell them every minute detail. This helps them to know that they're able to help you at your time of most need.