The Rational Basis® of Happiness Podcast

The Selfish path to romance. Download chapter one for free at DrKenner.com and Amazon.com.

How is he? His lungs are filled with fluid. His whole body is just shutting down. Even if we could get him to a hospital, there's nothing they can do for him there that we can't do here.

Maybe a decade or so ago, I got a phone call that my grandfather was dying, and I could fly down to Florida to say my final goodbyes to him with my uncle. And I chose that option. Before I left, I thought, What do I say to him? What do you say to someone who is dying? I had never gone through this before. He was the first significant death of a close family member that I was experiencing.

I read a book on grief, Death and Dying, by Dr. Terry Rando, in anticipatory grief. And what I realized was that the main focus needed to be on my grandfather as an individual, not to get all focused on, "Oh my God, he's dying," but to treat him like Grandpa.

With me to discuss this and other issues is Dr. Ed Martin, who is the Medical Director for Home and Hospice Care of Rhode Island. Welcome to the show, Dr. Martin.

Thank you.

Dr. Martin, with my grandfather, I felt much more comforted going down to visit him, knowing that the best gift I could give him was not to sit bawling at his bedside, crying, or to say my final rites or do something strange, but to really focus on what he needed at that moment. "Would you like a glass of water?" or "Would you like some soda?" I focused a lot on choices, and I'm wondering—you work with thousands of people who've been through hospice. What does hospice focus on in terms of the patient?

Well, we basically focus on keeping the patient at the center of our efforts. The fact that the first thing you did, the fact that you went, is probably, for some people, the most difficult step. Some people, when they hear that a friend or loved one is terminally ill, stay away. And I think that's the—

We've seen that with my mother-in-law. Some of her closest friends are not visiting her. She had a stroke.

Yeah, and people will shun because they feel uncomfortable. They say, "Well, what should I say? What will I do?" So they stay away. And that is obviously the absolute worst thing you can do. If anything, just even being there, being present, is important. And you're right. Once you're there, if you can focus on the individual and what they'd like to do, whether it's providing care, getting them a cold drink, or sitting with them while they reminisce or tell a story, really focusing on them is key. Oftentimes, we don't realize just how important it is even just to show up as a significant person in that person's life. That can be so important.

I understand it; it's difficult at times to feel, "What do I say? What will I do?" But just to go and sit with somebody who's a family member or a friend who's terminally ill, facing bad news—that alone can be so important.

I remember asking myself the question before I visited my grandfather, "What do I enjoy about him?" And that helped me focus. I remember the walks we took at our beach house together. I remember he wore a bathing cap, which embarrassed me as a little kid, so I didn’t quite tell him that, but he would take early morning swims—five or six in the morning—in the ocean. He was colorful, he was a fun person, and it was great to have that in focus when I went down there rather than the fact that he was dying. My uncle and I asked him, "Is there anything we can do for you or get for you?" And he said, "Sure, I'd love to see a tango." So I looked at my uncle, and he looked at me, and this was two days before he died. My uncle asked me to dance a tango in his hospital room, and we did. We didn’t have any music, but that’s what he wanted. I could never have predicted he would have wanted a tango at that moment.

So, in part, you don’t need a game plan. You’re a good listener, asking the person what they want.

Absolutely, and just being sensitive to what their needs are at that point. Some people find it helpful to bring photo albums or conversation pieces that help reminisce. Ultimately, we take our direction from the patient, whatever they feel up to at that point.

And having a backup plan, like a photo album, is nice too. If they don’t say anything, you can take the initiative. How do the caretakers at hospice help family members connect like this and avoid the opposite?

Hey, I gotta interrupt this because we’ve got to pay some bills. 30 seconds, that's it. A very quick ad, and then Alan will be back.

Romance. Oh, I wish guys knew more about what we want from a relationship. Boy, I wish I knew more about what I want. Where's that ad I saw? Here it is—the selfish path to romance, a serious romance guidebook. Download chapter one for free at SelfishRomance.com and buy it at Amazon.com. Hmm, The Selfish Path to Romance, that is interesting.

How did the caretakers at hospice help family members connect like this and avoid the opposite?

I think one of the things is supporting family members by just being there, understanding that this is difficult, but just being present is helpful. In our inpatient unit, we have very different rules than, say, the hospital. If the family wants to bring in a pet, like a dog or a cat, great. We don't have visiting hours in the inpatient unit. We encourage family to be there 24/7, much like they would be at home, to provide as much of a home-like setting as possible. In the home environment, we aim to not stress the person with too many visitors, but to provide enough support through this difficult time.

Hospice helps a lot with coordinating and facilitating communication among family members and the patient, right?

Right. And what happens when a family member comes in and is making it worse for the patient—they’re crying, bawling, or maybe it's an angry ex that comes back on the scene? How do you deal with those types of situations?

Occasionally, we'll have to sit down and say, "Look, we need to do what's best for the patient at this point." Sometimes family members aren’t as thoughtful as they might be about the patient’s situation or do things they think are helpful but aren’t. For example, a family member may try to force food on the patient, saying, "I want them to eat." We might suggest something else, like giving them a back rub or something they would appreciate and benefit from.

So you’re an advocate for the patient. If someone tries to force-feed or restrict their diet unnecessarily, you help the family see things from the patient’s perspective.

Exactly. We’re patient advocates, trying to maximize and improve the patient’s quality of life for whatever time they have remaining.

I assume, from my experience, that a family member usually calls hospice. But can the patient call hospice themselves?

Absolutely. At times, a patient living alone in the community will call hospice themselves. Many of our calls come from physicians, but when we get to the house, we sometimes find a patient whose family is scattered around the country. They may rely on friends or eventually a family member may come to help care for them.

If someone listening right now wants to contact hospice, how would they go about doing that?

If they call DHC Home and Hospice Care in Rhode Island, we're always available. We have staff available Monday through Friday, 8:00 AM to 4:30 PM, and for urgent situations on weekends as well.

If you’re around the country, you can look up your local hospice care.

Absolutely.

Thank you so much for joining us.

Thank you.

For more Dr. Kenner podcasts, go to DrKenner.com.

Here’s an excerpt from The Selfish Path to Romance by Dr. Ellen Kenner:

The main virtue that makes you lovable is rationality. Attempting to have a romantic relationship with an irrational person is a living nightmare. You cannot reason with an irrational person. Facts and logical arguments have no effect on them. You cannot understand them because they are full of unresolved contradictions. They are unpredictable because they often act on whim. You cannot feel fully understood because they don’t consistently use reason to understand you—all of this is anathema to romance. Furthermore, irrationality undermines all other virtues, as they are aspects of rationality. Irrationality, at its deepest level, amounts to rejecting facts and logic, which means rejecting reality.

You can download chapter one for free at DrKenner.com, and you can buy the book at Amazon.com.