A call you never want to get.
It was 2:35 am when my cell phone rang. My 80 year-old mother was on the other end and said she had brought Dad to the hospital. Then she said she wanted me to talk with the doctor and handed the phone to him.
The surgeon introduced himself and got to the point. My father had been admitted a few hours earlier with severe abdominal pain. Imaging showed he had lost circulation in areas of his intestines; tissue was dying and infection was spreading. He explained the complications and difficulty that surgery would present for my 85 year-old dad, who had been on kidney dialysis for nine years and had other serious medical conditions. He said surgery would be very difficult for a healthy person, but for my dad would be only 50% survivable.
He wanted instruction. I told him I’d get dressed and be right over.
—– The time will come when you will bury someone you love. —–
You will not be adequately prepared.
When this happens, however, you will probably be aided by some who have already experienced this and become members of what Albert Schweitzer called “The fellowship of those who bear the mark of pain.”
But, as someone who has attended over three dozen funerals in the past 10 years and who helps clients plan for the desirable as well as the unavoidable events of life, I have seen an entirely separate class of pain that can be completely avoided through effective preparation.
As you read this, you may find that it will not only help you identify steps to prevent unnecessary pain by filling gaps in your own plans, but may also open your thoughts to others who need to address their own preparation.
So, please read this with others in mind, as well as yourself.
The hardest thing a son will ever have to say.
I got the hospital about 3 am. The surgeon I had spoken with on the phone came to Dad’s room with another doctor and explained again the extreme difficulty of the situation and that surgery was not a very good option. However, the doctors had to leave that door open if the patient wanted surgery, even if it was unlikely to succeed.
After the surgeon left, the other doctor explained that the situation was much worse than the surgeon was explaining. She was there when the imaging was being done on Dad’s abdomen, and said that the infection and damage was already beyond any reasonable chance to repair. The difference between how the surgeon and the emergency doctor framed the issue were initially confusing. I later learned how the differences in their backgrounds and training influenced how they communicated with a patient and family. The bottom line: 50-50 survival was far too optimistic an estimate.
Over the next 4 hours, I spoke with 5 additional doctors who cycled into the discussion. Some were there to take direction, others were there to offer it. In the meantime, Dad’s pain continued to increase and he was given more medication to manage the pain. He became less coherent and less responsive.
As the window for making a decision about surgery was closing, I was introduced to the surgeon who would have been performing the surgery. He changed the dynamics and disagreed with the opinion of the first surgeon. He said that the surgery was maybe 20% survivable, and that if Dad defied odds and survived the surgery, he would never leave a hospital or nursing home again, and would be left with serious and painful conditions that would rob him of dignity and quality of life.
I asked him, “…but… what will I tell my dad?”
He said, “You will be a good son. You will tell him, ‘Dad – you are dying’”.
Dad and Grandpa – Two of my Heroes.
For many clients, my office becomes the first place they seriously address planning for the death of a loved one. Whether they are a young couple with a new family or are in their 80s, or even people my age who are helping their parents with some planning, it will be the first time they consider questions like:
If you end up in a coma next week, how will your medical professionals know what your wishes are?
Assume you don’t get better for a month: how the bills get paid?
If you never recover, what will happen in the first week after you die? How will your survivors know what arrangements to make for you? What steps have you taken to prepare them for the first months following your death and ensure that they are secure and well provided for? Do you know how income will change for your spouse and children?
If you have children and something happens to you and your spouse, do you know who gets to decide where your children will live? What will happen to ensure that your children or other heirs will receive your property?
This kind of basic contingency planning is much like owning a car. You know that simply by having a spare tire and jumper cables, you have prepared for the most common and easily resolved car problems. These are inexpensive solutions for simple and predictable situations. But without them, chances are you will someday create an inconvenience for someone else – if you are lucky enough to have someone around to inconvenience.
I already knew what Dad wanted.
Dad hated hospitals. I don’t know how many surgeries he’s had, but between multiple heart procedures, repairs to abdominal injuries, and procedures related to kidney dialysis, it’s a big number. Just the year before he died, he was in Intensive Care for days. He was hallucinating. I thought this was going to be the end for him. He didn’t know what was happening, and he told me later it was one of the most frightening experiences of his life. This from a man who was awarded a Purple Heart and Bronze Star with V for Valor while fighting in Korea. This was a brave man. A stoic man. A hero in every measure and meaning of the word.
But he feared and hated hospitals and was afraid of going into surgery and not coming out.
Korean War Memorial, Washington DC
Dad’s medals, pinned on his dress uniform at his funeral.
Several years ago I sat with my parents and walked them through the tough questions.
- What instructions would you want doctors and caregivers to have if you were not able to give those instructions yourself?
- Under what circumstances would you want to be resuscitated?
- When should life support be used and when should it be turned away?
I helped them fill out the Power of Attorney for Healthcare that named who they wanted to be responsible for healthcare and end-of-life decisions if they were not able to make those choices themselves. We also filled out the Advance Directives forms to provide instructions regarding, among other things:
- When they don’t want life-sustaining treatment and what other treatments they don’t want.
- Placing limits on how long they would remain in a coma or persistent vegetative state
- Requests for maximum pain and comfort care, even if it might hasten the dying process
Mom and Dad were able to talk about what they wanted and why. They argued with each other, of course. But when they were done, they had documents they felt would provide the right guidance.
Free Power of Attorney for Healthcare and Advance Directives forms are available online from several agencies.
These are hard conversations, but it’s important to start the conversation somewhere. Take a look at this AARP article about getting started.
Just one year before Dad died, I had helped my parents update their wills and add a community property agreement. Their attorney was an extraordinarily helpful and took care of the court filings after Dad passed. Everything went very smoothly.
According to the American Bar Association, 55% of Americans die without a will or an estate plan. Basic legal and estate documents are fundamental, and every person should make getting them a top priority.
Angels begin to appear.
The first angel I recognized was Dad’s renal specialists who had worked with Dad for almost 10 years and saw him several times a month. At this point, Dad was slipping in and out of consciousness, and his age and hearing loss made communicating with him about what was happening very difficult. That’s when this good doctor came into the room. He had been notified about Dad and came to see him. I talked with the doctor about what was happening and my struggle to communicate to Dad his situation. This good man, whose specialty put him in touch with dying patients on a constant basis, knelt by Dad, gently stroked Dad’s hand to wake him, and looked him in the eyes and talked to him until Dad seemed to focus. This doctor told him that taking him into surgery would be useless, and that his clock had run out. He said “I’m not going to let anyone hurt you, Alan. I’m not going to let anyone hurt you.” Dad nodded.
Then, this doctor – who deals with death regularly – walked with us into the hall and cried with us.
Here are four ways to avoid unnecessary suffering when a loved one dies:
Be Prepared
A very concise and comprehensive checklist of what you or a loved one needs in order to avoid financial, tax, estate and other complications can be found in the Resource section of our website.
Be in Control
By addressing the checklist and discussing, understanding and documenting what you want to have happen, you will have eliminated a great deal of the fear and tragedy that comes because of uncertainty and uniformed decision-making. You will have given your loved ones a great gift of peace. By taking action to ensure that a surviving spouse, children or others avoid having to wade through difficult decisions under painful emotional circumstances, you will have made their burdens lighter and enabled them to mourn together and be unified.
Being in control also means you minimize the risk of financial stumbles and help a vulnerable widow or widower reduce the chances of being taken advantage of.
Be Organized.
By organizing your financial, legal, estate, tax and other documents the survivor or beneficiaries will be able to make sure that income sources are not unnecessarily interrupted. They will be able to file for insurance benefits and make sure bills and other obligations get paid. If you are the one that handles online bill-paying and financial accounts, you will make sure that you have documented your online access so that survivors and not locked out.
A good guide list of things to include in your files can be found here.
If you are receiving Social Security, your file should include the resources to contact the Social Security Administration and change the benefits. See https://www.ssa.gov/planners/survivors/ifyou.html
If you are a veteran, there may be additional benefits including funeral honors. See
Delegate
When a tragedy happens, you will want to spend most of your time gathering with family and friends. Because you have organized well, you could turn over part of your instructions to a responsible son or daughter, for example, and have him or her take care of making sure the bills get paid or assist with applying for benefits or insurance proceeds.
Make sure that your home and property is looked after, that mail gets collected, that the house is watched during funerals and other times when the public may know that no one is home.
Another angel appears.
A few days after the funeral, I went to Dad’s credit union to close his account. I had my folder with legal documents and stepped up to the counter. The woman on the other side had helped my parents many times in the past, and was used to seeing me there helping with my parents’ affairs.
When I laid down the folder and looked up at her, I intended to say “My dad died. I’m here to close his account.”
But I could not say the words.
I felt the sobs lining up behind those words, positioning themselves to take advantage of the slightest opening so they break loose and rush out. I knew if I opened my mouth to say those words, it would be over. So I stood there unable to say anything. Probably looking a little lost.
Patiently waiting with a kind smile on her face, she quickly realized that was not a typical visit. She looked down at the folder and saw the edge of a death certificate sticking out. She immediately understood why I was there. She nodded knowingly. With a very gentle gesture, she motioned for me to follow her to a private desk away from the counter. As we passed the end of the counter, she turned and reached out to hug me.
The sobs found their opening and got loose.
Dad and Mom visiting us in Connecticut shortly after graduate school
Make your big decisions ahead of time.
By planning head of time with your attorney and financial advisor, you will be prepared to handle those few things that are timing-sensitive. Just as important, you will know that you can avoid making any other big decisions until you feel fully capable, comfortable and educated for them.
If your home, property, investments and other affairs are in proper order before a loved one dies, there should be no reason to make significant changes afterwards. Don’t make commitments while in an emotionally vulnerable state.
Conclusion
There are things that will be hard when a loved one passes. That’s the design of life. It’s one of the costs of loving and caring. We can’t fully prepare ourselves for that kind of loss.
But don’t let things be harder than they need to be. With planning, preparation and careful organizing, you can avoid unnecessary hurt and hardship.
You can find other useful guidance on organizing and planning in the Resource section of our website.
This information is not intended to be a substitute for individualized legal advice. Please consult your legal advisor regarding your specific situation.