February 4 Forum

Jeremy

Just to add some context to these late-life issues, I would note that it is often a matter of a family’s willingness to embrace a new framework. Can members of the family shift away from a focus on aggressive, potentially curative care, which is what everybody wishes they could get. The doctor is often reluctance to admit it’s time to shift from referrals to palliative care, even though hospice care is now appropriate, given that the patient is likely to be living for an average of maybe no more than a week or two. The life span reported by the physician might be six months; however, it almost never is that long.

Once in a while, you’ll meet a person who says, “My doctor sent me to hospice, however, I’m still alive.  You know, it’s a year later.” That is a very rare experience and delightful, of course. However, Services such as Hospice are underutilized, even the ones that are well established. That makes it difficult to assess the value of referral to Hospice, because there’s a lot of discomfort around these kinds of topics. The letting go piece is not a popular subject.

Bill B

We can think about the late-life issues from the perspective of wellness. There is a strange attractor here, it’s called death. So, it’s easy to get pulled into the issue of death.  What about life?  For instance, Mark, I’ve become aware that music has become a more important part of my life in recent years. For instance, I find myself really enjoying string quartets. When I was a teenager, they all said, someday you’re going to listen to a Beethoven late quartet and you’re going to appreciate it. I kind of understand this music now.  So, if I had a late-life doula, which I wish I did, I would want this person to sit down with me and ask: what are you doing about this kind of new appreciation for music?  How are you savoring it?  From there, the doula might expand their inquiry. Bill, you’ve got some problems with mobility, so how are you going to attend music concerts?  Financially, how are you going to afford music rather than something else in your life?  How do you set up priorities?  And guess what, Bill, it’s not crazy that you’re loving music, it’s kind of what happens to some older people. There are even cortical shifts that occur that make certain sensory sensations more vivid for you as you grow older and other ones less vivid.  So, what are all those about?  So, these issues being brought up by my potential late-life doula are not just about death – or even just about illness. They are about wellness and the priorities that emerge during late-life.

Jeremy

You know, as you’re stating, late-life doula engagements involve dynamic conversation. It almost sounds like late-life coaching. I’m wondering language-wise, what we should call these services. Doula kind of connotes one thing. Maybe it’s some combination of those two words. Because these services sound more like coaching than like doula services –at least historically as the doula services have been provided.  I don’t know.