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“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Friday, December 10, 2004
    Advice for a Worst Case Scenario

    I'm posting an email (slightly edited) that I recently sent to a friend whose father-in-law was diagnosed with terminal cancer. (He was kind enough to say he'd found it helpful, which is why I'm posting it.) This is the advice I'd give to anyone with a friend or family member who has a serious illness:

    Here's my practical advice: prepare for the worst. (Things will go much better and be less emotionally/financially traumatic if you do.)

    [Your relative] may live for several months more, but don't count on that. Start talking to hospices now: That doesn't mean throw your hands in the air and give up, but they can offer valuable support if the patient's immediate family lives out of town. Hospices hate being called in at the last minute, and you can get so much more benefit from them if they get involved early on.

    If [the patient's] affairs are in order, that's a great thing and one less issue for you to worry about; if not, start getting things straightened out, STAT. If there is no durable power of attorney for the patient, get one. If the patient has no attorney and no will, get one done while he/she is still competent to do so.

    Over the years, I have developed one piece of advice for friends and family of the patient in these cases: when they ask, "When should I go to visit?" my answer is always "now." This is not really based on life expectancy but on the quality of interaction with the person. Better to visit early when they are still compos mentis and able to appreciate the visit than at the end when they're deathly ill and/or narcotized and cannot interact with visitors.

    I hope most people won't need to use this advice, but life being what it is, I thought it would be helpful to some.



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