“Jack” was a vaudeville magician. Now he is close to death, lying in a hospital bed. His priest, Doug Smith, enters his room alone. “We've been waiting for you,” Jack says. “We are going to initiate you into the International Brotherhood of Magicians.”

Jack begins to chant magical words and sounds.

He asks Father Smith to come closer to him. Father Smith does so, and looks into Jack's eyes, which seem to look right through him.

Jack asks the priest to come closer again. And again.

When they are nose to nose Jack says, “Watch me disappear.”

And he did. Jack died.

Later, Smith said that if he had told Jack no one else was in the room, or dissuaded him in any way from sharing this with him as he did, Smith would have “... ruined something that was very meaningful to Jack.”

Several audible wows were heard in the Harbor Theater during this scene of the movie, “Consider the Conversation: A Documentary on a Taboo Subject.”

Approximately 100 people came to the Harbor Theater for Lincoln County Healthcare's public presentation of the film on May 15. The film asks viewers to think about how, where and with whom they wish to die when that time comes.

The 60-minute documentary presented medical and legal personnel, terminally ill patients, hospice volunteers, spiritual leaders, a journalist and family members speaking on the subject of death and dying from their perspectives.

Gwen Cole, RN, CMSRN, Community Liaison Nurse for Miles & St. Andrews Home Health & Hospice, organized the event and panel discussion that followed.

The panel included the Reverend Dr. Sarah Foulger of the Congregational Church of Boothbay Harbor, Family Physician and Hospice Medical Director Rob Hunold, Kathy Bean, Executive Director of Miles and St. Andrews Home Health and Hospice; and Attorney Chip Griffin, whose specialty is elder law.

Boothbay Harbor resident Robert Shepard asked Rev. Foulger how she handles situations with very religious families that believe death is the permanent end of existence. Foulger said she shared her faith and that was all she could do. She also commented on the piece about Jack.

“I have watched many people die and I am absolutely convinced that this physical world is not all there is to existence,” Foulger said. “The people near death seemed to be between two worlds and there were other people in the room they were talking to, I couldn't see them, but they were there.

Hospice

During the panel, questions arose about how and when a person may be referred to hospice and why some prefer to wait until the last few days to call.

Dr. Hunold explained all that was needed was a letter from a patient's physician stating that the illness/disease they have, if left untreated, would leave them with six months or less of life.

Kathy Bean said by planning ahead of time you can bring important people in that person's life into the scene, enough of who that person is into the scene.

“Most nursing home and hospital caregivers know when the transition is happening,” Bean said. “We can get in there soon enough to make a difference in those last days – its that type of situation.”

Stephanie Berry, a hospice volunteer, related a story about a recent patient. The gentleman was a great-grandfather who had not seen his new great grandson. “The family was so reluctant to admit things were changing for him, Berry said. “I had to really sit down with them and tell them it was time to bring the baby to him – whatever it takes.

“He saw the baby on Wednesday and died on Sunday. It those kinds of things that are so important to patients, it really makes all the difference.”

Another example of how hospice can make last wishes a reality was shared: a photographer in his mid-40s was terminally ill and expressed a wish to see his photographs. But, they were all on slides. A hospice volunteer, nurse on the case and others found a projector for the slides and other accoutrements needed. For three days his mother worked the slide projector and he was able to view his photos until his last breath.

Hospice volunteer Pat Yetman related having difficulty getting her own family members to accept hospice, even though she was a hospice caregiver herself.

“I have had great difficulty to get them to accept hospice as a means to have a greater quality of life. Could not convince aunts and uncles … by the time my uncle finally did agree to hospice he died within three hours.

“Everyone here should think about it – if you have a terminal illness, when treatment no longer works, you really should think about hospice because it can help the whole family.”

Advanced Healthcare Directive

An Advanced Healthcare Directive goes far beyond a living will: it names a power of attorney (POA), someone you have named to make decisions for you should you become incapable to do so. Griffin said he is asked about, and draws them up every day.
“For many people it's more important than a will,” Griffin said. “You are empowering someone to make a decision for you. It designates your physician, organ donations, what type of service and life saving measures you want and under what conditions. It is a powerful document.”

Some families have issues with following the wishes of their loved one. And, as Hunold said, for the most part they are involved, but in his experience, most families make these decisions in consensus. Less than five percent are contentious.

Hunold advised putting thought into who your POA is.

“To be the POA you have to be open-minded enough to make the decision and ignore your own thoughts about dying. The dying process can be quite complicated and the POA might need to answer questions for situations that arise that were not addressed in any form. It is very rare in this community in the six years I've been here, I can't remember a time when there was a significant disagreement between the POA, patient and doctors.”

“Too few people have this conversation,” Bean said. “People are living longer with chronic diseases. We have a lot more time in our lifetimes to make these decisions and plans. But, we find people come to the end of their lives and so much energy is spent on what to do and how to do it. We provide support for people for what they want – environment, family, and manage symptoms that need to be addressed, we work as a team to provide need and see to a person's wishes at the end of life.”

Clips from “Consider the Conversation” can be viewed on YouTube. It is the first of three documentaries being produced by Michael Bernhagen and Terry Kuldhasal.