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00000181-fa79-da89-a38d-fb7f2b15000000000181-fa79-da89-a38d-fb7f2b16000000000181-fa79-da89-a38d-fb7f2b170000There are conversations doctors have with patients, that doctors have with themselves and that families should have with each other concerning end of life. KUOW brought together a panel do do just that: talk about death over dinner. Food was provided by chefs Debi and Hayden Smissen, who designed the menu while his own father was dying.Host: Ross Reynolds, KUOWDr. Cat Saunders, Seattle counselor and death doulaDr. Greg Vandekieft, palliative care physician Trudy James, MRE, hospital chaplain. She also has made a movie about conversations on death called "Speaking of Dying."Dr. Anthony Back, oncologist and palliative care physician"He allowed himself to be swayed by his conviction that human beings are not born once and for all on the day their mothers give birth to them, but that life obliges them over and over again to give birth to themselves." - Gabriel Garcia Marquez, from "Love in the Time of Cholera"While the panel enjoys a plate inspired by the flavors and symbolism of spring, they discuss a key question: "Why talk about death?""Youth is happy because it has the capacity to see beauty. Anyone who keeps the ability to see beauty never grows old." -- Franz KafkaThe panel discusses what it means to live well, all the way to the end of life."We don't grow older, we grow riper." -- Pablo PicassoOne attitude patients and families sometimes face is the idea that death constitutes a "failure" on the part of the medical community. The panel discusses methods of better communication with your doctor concerning end-of-life care."Someday, somewhere - anywhere, unfailingly, you'll find yourself, and that, and only that, can be the happiest or bitterest hour of your life." --Pablo NerudaFor the final course, both the meal and the conversation comes full circle as the panel gives their final thoughts on how to talk about death with your family and why it's so important to start now. to throw your own “death dinner”? Visit the organization Let’s Have Dinner And Talk About Death for inspiration and ideas.

Delivering Grim News – It's All In How You Say It

Greta Austin's family faced the issues surround end-of-life care when her father, George Austin, was diagnosed with cancer. He is pictured here with his wife, Shirley, On Easter Day, 2013.
Courtesy of Greta Austin
Greta Austin's family faced the issues surround end-of-life care when her father, George Austin, was diagnosed with cancer. He is pictured here with his wife, Shirley, On Easter Day, 2013.

Greta Austin has spent a lot of time in medical waiting rooms.

Two years ago last fall, her father came to Seattle from Wisconsin for treatment, and she sat with him at the Seattle Cancer Care Alliance.

“It’s this moment of incredible anxiety,” she said. “You sit in a waiting room, and you’re looking out at one side, you can see the highway going north to south, looking out you can see the lake going to the ocean.”

That was a metaphor for the people in the waiting room, not knowing what direction their lives would take. They’re waiting to get treatment, to hear about test results – waiting, not knowing. “It’s a very liminal place,” Austin said.

Austin’s father had a scan to check out a blockage in his stomach. The family was about to meet the oncologist to go over the results. It didn’t look good.

“There was a cancerous mass in the pancreas,” Austin said. “It had metastasized and blocked the bottom of his stomach.”

Hearing that news was hard. But what struck Austin was the manner of  the oncologist at SCCA, Dr. Tony Back. “The way in which Dr. Back delivered the news was with so much compassion and humanity,” she said.

There would be many more meetings with Back. At each visit, the family would list their questions and worries, and he would answer them one by one.

“He’s dealing with a tough crowd, my two siblings, one is an oncologist, one is a pathologist,” Austin said. “He grounded his answers very much on the facts, but it was just never about the facts. It was, ‘Let’s give you the quality of life the best that we can.’”

Austin said Back took the time to get to know her father – a man who loved basketball, and who was an avid birdwatcher with an enviable list of birds he had seen.

WATCH: KUOW's Death Over Dinner Conversation, featuring Dr. Back

Health care is usually focused on treatment. But there’s growing recognition that a doctor’s communication skills are just as crucial. Traditionally, that’s not been part of doctors’ medical training.

But that’s slowly changing.

Back said there’s a myth that doctors who are warm and friendly may not be up on the latest in medicine, and those who have the science down are cold. “You don’t have to choose between those two things,” he said.

[asset-pullquotes[{"quote": "Seeing The Humanity In Everybody", "style": "full"}]]Back has been interested in how physicians communicate with patients since he was a medical student. One incident, in particular, stands out.

Back was part of an oncology team making rounds at a hospital. An elderly patient had been admitted the previous day for a blood disorder. The team was on its way to see her. The attending physician asked the doctor in training about the patient.

“The fellow looks up at him and said, ‘Well, Mrs. So-and-so died.’ Just like that. The attending physician kind of nodded and goes, ‘She was an old trout.’”

Back couldn’t believe what he had just heard. “I was like, ‘Oh my gosh, that was so callous!’” He didn’t know her, but she was frail. She could have been someone’s mom. “We clinicians need to do a better job with seeing the humanity in everybody,” he said.  

[asset-images[{"caption": "Greta Austin's family on her father's birthday in May 2014. Back row: Clark Lombardi, Greta Austin. Front row: Shirley Austin, Cecilia Lombardi, George Austin, Chiara Lombardi", "fid": "116893", "style": "offset_left", "uri": "public://201504/deathseries_gretafamily_0.jpg", "attribution": "Credit Courtesy of Greta Austin"}]]The incident led him to believe that doctors aren’t equipped to talk about such intense situations. He realized he wasn’t getting that kind of training in medical school.

He sought his own training over the years. Midway in his career, he started a nonprofit program to help doctors learn from their blunders. It’s not just knowing what to say, but also learning what’s important to patients.

What Back likes to do is ask patients to show pictures from their cell phones.

“It will tell you a lot about what’s important because who’s in the picture, what they were doing, how long ago that was,” he said. “Those are all clues to me about whether someone is living in a way that they’re getting some living done every day, as well as taking care of their illness.”

Back said studies show that when patients are plugged in to what gives them joy, they do better. They’re able to weather the challenges ahead. 

These conversations helped Greta Austin’s father think about what he wanted to do with his remaining time. A big goal was to go back to Wisconsin to see the warblers in their spring migration.

“If you had told me that he would go back to see the migration when he first came to Seattle, I would have said no way,” Austin said.

But he did. He lived almost two years and was there for big family events. Austin said the experience made her appreciate that medicine isn’t just about science – diagnosing the illness and coming up with the right treatment. It’s also about communication, the ability to bring out what matters most to people. 

Year started with KUOW: 1994