“I pray for peace,” said the man with advanced cancer. He was a new in-home hospice patient I was visiting for the first time. Turns out, I knew his wife as a coworker at the nursing home from years before — she was a nurse, and I was the chaplain.
We were sitting in the upstairs bedroom of their suburban home. He was in a wheelchair, and I was sitting in front of him. His wife was in a chair on the other side of the room. I often ask patients, “Do you pray?” And like most everyone else, this man replied, “Yes.”
“What do you pray for?” was, of course, my next question. “I pray for peace,” he immediately responded. Across the room, out of sight of my patient, his wife was shaking her head, as if to say, “That’s not what I pray for.”
As we walked down the stairs on my way out, she confided, “I pray for a cure.” That was totally understandable.
This scene came to mind as I listened to a recent GeriPal Podcast titled, “What Makes a Good Death?” I have also explored this topic in a previous blog, “Can a POW Have a Good Death Hundreds of Miles from Home.”
Peace is more important to patients than doctors imagine
Photo by Raphael Nogueira on Unsplash
The “GeriPal” podcast focuses on geriatrics and palliative care. Each week, they feature the latest research on a variety of topics. Last week, they were revisiting the idea of a good death from the perspectives of patients, families, doctors, and other healthcare professionals. They also discussed a new paper comparing and contrasting the idea of a good death as found in Brazil versus the United Kingdom.
One of the surprises in the research is that although patients felt being at peace was important, physicians did not believe that it was that important for a “good death.” Another curious finding was that doctors rated being pain-free higher than patients did. Perhaps that was related to the finding that patients rated being mentally aware as more important and doctors not so much.
Control in Brazil v. the UK
Photo by Marcin Nowak on Unsplash
Another interesting finding was the idea of being in control of the dying process. Folks in the United Kingdom ranked being in control as very important. Responses from Brazil were essentially, “What do you mean by ‘control?’ God is in control.” This, of course, reflects the more religious leanings in Brazil compared to the more secular UK.
The bottom line — listen to patients
Researchers concluded by warning all of us not to make assumptions about a particular patient or their family. Yes, there are often common ideas about what constitutes a “good death.” But this particular patient might not agree. So, we need to stay curious — and ask.
The whole podcast episode is worth a listen or, at least, read the transcript.
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Author Chaplain Hank Dunn, MDiv, has sold over 4 million copies of his books Hard Choices for Loving People and Light in the Shadows (also available on Amazon).
From a 
Both the patient and her husband assured me that she would get whatever pain medications she needed and that they have talked about those important things. I believed them on both counts.
I can understand that a person may not want to know their prognosis because predicting how much time a patient has is so difficult. A Facebook friend recently posted, “One year ago (May 23), I was told I had 6 months to live. I’m still here.”
@hospicenursepenny’s thoughts on the importance of talking about it
This outlook did not come easy for her. This book is, in part, a memoir about how a troubled young mother survived her own addictions and reckless living. Her life story is woven into the fabric of a book to help people have a better death and, she hopes, have a better life.
Questions and comments from Smith’s social media followers appear in Influencing Death, allowing segues to practical end-of-life advice. Here are just a few nuggets of Penny’s wisdom found in these pages:
Nothing to Fear: Demystifying Death to Live More by Julie McFadden, RN, is the latest in a long line of books showing the way to a more peaceful and more meaningful dying experience. Why another death and dying book? Why not? Sitting at #8 on the New York Times “Advice” best-seller list, Nothing to Fear is full of advice about navigating the last six months of life under hospice care.
Throughout Nothing to Fear we see nurse Julie addressing spiritual concerns of her patients and their families. She devotes a whole chapter, “Deathbed Phenomena,” to stories about patients having visions of long dead relatives. Here’s her understanding of these experiences returning to her theme of the metaphor of birth:
I am guessing if, during that last phone call, Favre asked, “Do you regret getting the chemo?” Keith might have responded, “Not at all.” Perhaps it bought him some time. Maybe, earlier in the treatment, he did not think it was causing “more damage… than the cancer.”
To qualify for hospice under the Medicare benefit, a physician has to say, “This patient has, at most, six months to live if the disease runs its normal course.” What happens if the prognosis is wrong and the patient is still alive after six months?
