This is my first post! I will write from time to time on subjects about which I feel passionate, confused, or concerned. Today, I would like to share thoughts about the end of life. Having just finished Atul Gawande's book, Being Mortal, I feel more committed than ever to encouraging those I work with to begin conversations with themselves and their loved ones about what they want life to look like not just in their final days but in their final years. Reading Gawande's book would be a helpful place to start. The many stories of his relatives, friends, and patients provide us with as many opportunities to assess our own reactions to their sometimes gut-wrenching dilemmas. Do their decisions make us cringe, cry, sigh with relief, nod in agreement, or want to change the subject? The emotions these accounts trigger give us insights into our own vulnerabilities and can steer us in the direction we need to be headed.

One of the most important messages Gawande delivers is about the importance of safety when deciding what an aging person needs. Safety is big amongst medical professionals but when safety is the driving priority, he says, a person almost always loses what is most important to him or her. A woman I worked with who had pancreatic cancer had few wishes except that she be allowed to die at home. Despite her strong and very clear convictions about this, some family members insisted she would be "safest" in an assisted living facility. They were reminded that she fell previously while in one of those facilities so safety was not a guarantee there. Feeling desperate, they eventually challenged, "What if there was a fire? She can't move quickly anymore and might eventually even need a wheelchair." The poor woman finally had to shout, "If I burn in my apartment, so be it. I want to die in my home!" She shared that one of the saddest things during this time was not having to fight for her life but having to fight continually for how she wanted her last weeks of life to be. For some, safety may be what will give them the most peace and comfort and if that is the case, that is what they should be given. But Gawande reminds us that our goal should be to help those we love figure out what they want, not decide for them or convince them (when they are most vulnerable) to agree to what we think is best.

Of course, the most ideal circumstance is to have done a good bit of thinking about this topic before we are actually faced with it. Hopefully we will have also shared these thoughts with someone we trust who has both the compassion and the mental stability, during a very difficult time, to help us carry them out.