Insights

The ‘Wonderful World’ of Advance Directives

It was one of those things that happen in a city: a busy Saturday night, full restaurants, and elbow to elbow dining. The perfect milieu for people watching and eavesdropping. The table next to us seemed to be a mother and son, their shared facial features were unmistakable. Even though my husband and I were taking the evening to reconnect and catch up, away from our teenagers, I was riveted by the two of them. He sported a blue blazer and dress shirt, whereas she was hunched over in an old cardigan and knit blouse, white hair uncombed and sticking straight up on the right side of her head.

While it was a festive atmosphere in a fashionable neighborhood before the evening’s Symphony and Opera performances, she didn’t look happy to be there. However hard he was trying to draw her out, she only responded in one or two words. I wondered if her demeanor was a result of some dementia, but when he asked about some of her activities at her residence, she said: “I don’t like the bridge group.” “Not enough of a challenge?” he inquired. “Too much chit chat” she declared. She’s still got it! I concluded.

We ate our salad course and talked about the impending closure of a practice I started five years ago, Good Medicine. I lamented to my husband (for the hundredth time!) that our services, including advance care planning and end of life counseling, were just not valued enough by our society to support four full time staff.

“I wish everyone knew how important this is,” is something I’ve said to myself and others over and over.

“Too difficult of a topic”, “Our society is not prepared to deal with death and dying,” “No one cares what happens when someone else is paying,” are some explanations that have offered. In the quest for building community awareness and drumming up some business,  I have given several community talks in the past four years, and written an opinion piece in Time.com.

I tell people that the twenty to thirty percent of Americans who have Advance Directives is woefully inadequate—and that many of those are simply documents sitting in a file drawer somewhere, and not representative of a real process or discussion. People nod their heads emphatically when I speak, but I have often wondered if anyone is really listening.

Around the time we were finishing dessert, I overheard that their conversation had shifted to the illnesses and funerals of several longtime family friends. The son queried his mother about a friend’s long-time illness and prolonged hospitalization. “Not for me.” she declared. “I would call myself a taxi if they couldn’t fix me up within a few days.” “Is that so?” her son asked, very interested. “I hate hospitals” was her only explanation. Her son was smiling as he cut his meat, not making eye contact, but clearly enjoying the repartee and valuable insights. “What do you hate the most about them?” he asked “Too many bright lights, thin blankets and lousy food”, and then, unprompted “AND..I don’t like strangers touching me!” she said with a fierce gaze.

Her son was visibly suppressing a giggle. The talk diverted to her friend’s funeral.  “I couldn’t believe how many people were there” he remarked. She scowled. “I didn’t like the music”. Pregnant pause. “Well Mom” he started, and then cleared his throat. “What music would you want, you know…. for yourself?” Though she didn’t change her demeanor an iota, her response was immediate: “What a Wonderful World” she declared. He let out a hearty chuckle. “The Louis Armstrong recording, not Tony Bennett!” she commanded with a wag of her index finger.

I smiled broadly as my husband signed the check and we pushed our chairs back. I wanted to lean over and give the son a pat on the shoulder, but of course, I could not. It occurred to me that maybe people are getting the message about talking to loved ones about the end of life. When we walked out of the restaurant, my mind was filled with thoughts about the vagaries of old age, Louis Armstrong, and gratitude for Good Medicine and good families.

Click here to listen to: What a Wonderful World

 

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