COMMUNICATING IN TIMES OF TRANSITION

Yesterday, Community Ethics colleagues and I met with maybe 30 surgical ICU doctors and nurses at Massachusetts General Hospital. We discussed the increasingly complex end-of-life decision-making process at a time when technology can maintain a pulse and breathing long beyond when patients could have done so on their own.

This morning, my wife and I presented a forum at our daughter’s elementary school. There were maybe 30 parents, officers from the local police, and the vice principal. We discussed the increasingly complex cyber world that can bring strangers into the bedroom, bullies onto a small screen, via devices our children understand better than we do.

There must be a word for an echo on a blog -- a blecho, maybe. Do you hear it? I do.

With a dying patient, the difficulty can be knowing what the patient would want, when that patient is beyond communicating. Similarly, there’s difficulty in ascertaining what is going on in the social life of an uncommunicative teen. Both are in compelling transition: one to life’s end, the other to adulthood. Neither is a time of great clarity. Both involve power struggles, loved ones facing hard choices, and require ongoing communication, trust, and respect -- when none of those come easy.

A cyber-savvy police officer said at the school forum: “Technology will change every day. But the fundamental (coping strategies) won’t change.” And, “Today, communication has to be increased 100-fold with your child.”

I’m thinking that in both cases, a simple list of fundamentals would be helpful. This is what Atul Gawande writes about in “The Checklist Manifesto.”

So what’s on your list of fundamentals for end-of-life care?