All of us have an expiration date when we are born. It’s just that it is not printed anywhere so that we can know what it is. Even those of us who have been diagnosed with a life-threatening illness are very aware that they have an expiration date. Interestingly, physicians have found that predicting expiration dates is a very inexact science.
I was listening to Rush Limbaugh’s final radio show of 2020. Rush is fully aware that his expiration date is sooner than most as he was diagnosed with stage 4 lung cancer earlier last year. His message to the listening audience was profound in that he has become acutely aware of lessons that are importance for all of us. Rush talked about forgiveness and love and what has been so generously and kindly expressed towards him. He was in awe of the love from so many people he has never met and will never know. Rush got it right in that he is thankful for the love and generosity of the public and his family.
There is a palliative physician named Dr. Ira Byock who wrote the book, The Four Things That Matter Most.
- Please forgive me.
- I forgive you.
- Thank you.
- I love you.
Certainly not everyone needs to say all four things but they are a valuable reminder of how we should treat each other every day. They become very poignant when faced with a life-threatening illness.
I have worked with cancer patients for many years as a palliative care nurse case manager. Each person faces their mortality with some anxiety and trepidation but as they get closer to their expiration date, they often leave lessons for the rest of us. I made it a practice to teach the value of saying the four things that matter most to most patients and families. The lessons and feedback returned to me were amazing.
Conversations with families
Two wives told me that the final words from their dying husbands to them were, “I love you.” One wife told me that her husband said to their adult son “I love you” for the first time, only a few hours before he died. These are the good memories that they will keep.
Another man was able to speak to family members he hadn’t communicated with in some time to tell them his final words and thoughts. Per the son, his father expressed all of the four things to his family.
One daughter asked her mother, “Please forgive me for all the times I wasn’t the best daughter I could be.” The forgiveness went to both parties.
Another daughter told her father, “Thank you for being the best Daddy for me.”
In my observations, we don’t always practice the four things on a regular basis. Those of us who do not may be left with major regrets for things not done and or not said. Advance care planning can be a good practice to help begin to correct that negligence of practice.
A family I worked with completed advance directives for each member. When the elderly mother died, they knew exactly what was important to her and were able to complete her wishes as instructed. One of the daughters thanked me at the funeral for helping the family complete advance directives.
On a personal note, I have been given a diagnosis of breast cancer and congestive heart failure. The breast cancer is currently in remission but congestive heart failure is a progressive disease. It can be managed for many years but often 50% of those with it may die within five years of diagnosis. For me, so far so good. I am managing both with as much grace and care as I can muster and am very lucky to have excellent support from family, friends and caring physicians.
I have had time to review my advance directive and realized that I didn’t wish to make any changes to that document. My doctor has a copy as does my hospital. My family are all aware of what I want and don’t want, especially with thoughts towards what happens if I get COVID-19.
Advance care planning should include the following: advance directive for health care; health care proxy; power of attorney for finances and a will. They should be updated when changes occur or on a routine basis to make sure they meet current wishes. Once done, they can help avoid family arguments or second guessing about what is important to the patient. My advance directive is Five Wishes because it covers the medical, legal, personal and the spiritual. Remember, no one is promised tomorrow and predicting an expiration date is an inexact science. I think of completing advance care planning as an act of love for my family. With any kind of luck, you won’t have to use these documents for many years, but you never know.
Leslie Piet, RN, BSN, MA, is a nurse who has served the community surrounding Baltimore, Maryland, for more than 40 years. She co-authored the reader’s guide to The Four Things that Matter Most by Dr. Ira Byock, has given numerous workshops on advance care planning, and serves on the Board of Directors of Aging with Dignity.