Yesterday, I made the possibly ill-advised decision to binge-watch season one of The Pitt. Well, actually, it was less of a conscious decision than a compulsion: once I started, I just couldn’t seem to hit pause.
Even if you’re not a big TV person, you’ve almost certainly heard about The Pitt, the medical drama set in a Pittsburgh emergency room. Beyond sweeping up a bunch of major awards at the Emmys last year, the show has attracted buzz for its hyper-realistic depiction of the modern healthcare system. The first season — which chronicles a single shift in the ER, hour by hour — struck a chord not just with the general public, but also specifically with healthcare professionals, many of whom say it’s the most accurate portrayal of hospital life they’ve seen.
While I wouldn’t necessarily recommend anybody else blast through fourteen hours of intense medical drama in a single sitting, I can personally attest that The Pitt is a fantastic show — not just because it makes for entertaining TV, but also because it has some important lessons to impart about facing some of life’s biggest challenges.
With season two of The Pitt launching this week, now seems as good a time as any to talk about some of the show’s biggest takeaways. There’s one storyline that stuck with me because I think it illustrates something really crucial about Aging & End of Life Planning — something that often goes completely overlooked by families and planners alike. It points to one key ingredient that is absolutely essential to effective Planning… and when it’s missing, you can be almost certain that there will be trouble down the road.
Setting the scene
I’ll keep this blog post free of major spoilers for The Pitt, but for the purpose of this discussion, I do need to talk about one minor plotline from early in the show.
Starting in episode 2, one of the team’s ER patients is an elderly man named Mr. Spencer, who’s accompanied by his two adult children. Mr. Spencer suffers from Alzheimer’s, and he’s been hospitalized with a bad case of pneumonia. As his condition deteriorates, it becomes clear to the medical team that Mr. Spencer is likely at the end of his life. They are all strongly against putting him on life support or doing any kind of invasive procedures to extend his life, because they know that they are all likely to cause suffering while delivering minimal benefits.
Here’s where the element of Aging & End of Life Planning comes in. As it turns out, Mr. Spencer must have read some Viive blog posts at some point in the past, because he’s fully prepared for this scenario: he has a DNR (do not resuscitate) order in place, as well as an Advance Care Directive indicating that he does not want to be intubated or placed on life support.
But things get complicated with Mr. Spencer’s children in the picture. Both of them have Power of Attorney, allowing them to make healthcare decisions on their father’s behalf (which is normally a good thing!). However, they’re on different pages about how to proceed. Mr. Spencer’s son seems open to the idea of honouring his father’s Advance Care Directive, but is still hesitant about declining life support. Meanwhile, his daughter is fully against following the Advance Care Directive, and insists that her father should be given treatment in the hopes that he’ll get better. The rest of this B-plot follows their decision-making, with them first choosing to override their father’s wishes before eventually agreeing to remove him from life support and allow him to die a natural death.
The missing ingredient
At first glance, this fictional scenario seems like an Aging & End of Life Planning success story. Mr. Spencer has all of the most important documents in place, from Powers of Attorney to an Advance Care Directive. He’s done a lot more preparation than most (consider the fact that only one third of Canadians have made a Power of Attorney).
But as this family’s dramatic storyline reveals, Mr. Spencer’s Aging & End of Life Plan is missing one essential component: open and honest communication. Even though their father recorded his wishes in writing before his Alzheimer’s disease advanced, his children do not feel prepared to honour his Advance Care Directive. They butt heads both with the medical team and with each other. Mr. Spencer’s daughter, in particular, insists that declining life support would be the same as “giving up” on their father, which she refuses to do.
This is a perfect illustration of why Aging & End of Life Planning isn’t just about paperwork. Having all your legal and financial documents in place is incredibly important. But unless you’ve had a clear, open, and direct conversation with your loved ones about what you want to happen and why, there is still a risk that your intentions won’t be honoured — or that complications could arise when they are.
What could the Spencer family have done differently? In addition to all the preparation that Mr. Spencer already did on his own, it probably would have been helpful for him to sit down with his children for an in-depth, vulnerable discussion about his wishes. This would be an opportunity for him to very clearly explain why he made the choices he did, and give his children an opportunity to begin processing that information. It would also have given them the space to ask him questions, voice their concerns, and respond emotionally to his Aging & End of Life Plan. This conversation could also be an impetus for the two siblings to talk to each other about their father’s impending passing, and lean on each other for support.
Losing a loved one is never easy. Processing loss brings out all kinds of emotions, and when you’re in an environment like an emergency room, the stress combined with all those difficult feelings can make communication even harder than usual. When families incorporate communication into the Aging & End of Life Planning process, it means they get to do it on their terms, under better circumstances. That way, when difficult situations arise, they’re ready to face them with more calm and confidence. It doesn’t make loss any easier to handle — but it prevents other problems and conflicts from complicating the situation even further.
Last words
There’s another way that communication becomes important in the Spencer family’s story. After some time has passed and the siblings have decided to take their father off of life support, they are left sitting by his bedside, waiting for him to pass. To help them say goodbye to their dad, our main character Dr. Robby tells them about a traditional Hawaiian practice called ho'oponopono. As he explains it, ho'oponopono is a prayer that consists of four simple phrases:
- I love you.
- Thank you.
- I forgive you.
- Please forgive me.
In the very emotional scene that follows, the siblings both talk to their dying father about their memories of the childhood he gave them. His daughter shares the difficult feelings she had as an adolescent, when she was embarrassed by his job and his goofy personality, and asks for his forgiveness. And most importantly, they tell him that they love him and thank him for everything he’s done. It’s an incredibly touching and beautiful scene, and a testament to how much simple communication can help during difficult times.
It may sound cliché to say that communication is everything — but it’s always worth repeating. Too often in Aging & End of Life Planning, people focus too much on the paperwork and not enough on the human element of things. At the end of the day, Aging & End of Life Planning isn’t about money or property; it’s about people. It’s about taking care of the ones you love, even after you’re gone. In order for that to work, you have to let them know.
