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Dr. Risa Bordman, Palliative Care

Risa Bordman is a Family Physician with a special interest in Palliative Care. She is an Associate Professor at the University of Toronto where she enjoys teaching and working on a variety of research projects.Read More
She is married to Joel Bordman and has 3 sons, Zachary, Daniel and Eli.


Risa’s Message 

Shimon Peres, the great Israeli statesman died this past week and while much has been said about his life’s work, I want to talk about his death. No, not who said what at his funeral, but what happened from September 13 on, after he suffered a massive stroke. According to media reports he was sedated and placed on a respirator. The details of the next 2 weeks are sparse but I think most of us can imagine what transpired. Family and friends gathered around his hospital bed, there were ups (he squeezed his son’s hand) but mostly downs, as he failed to regain power on his left side or breathe on his own. He son Chemi Peres, told reporters: “This is a difficult time. We will have to make certain decisions.”
 
It is about those decisions that I want talk with you today. How many of us have thought about how we want to die? Most of us have drawn up wills or at least contemplated writing one, some of us have pre-arranged funerals; but what about the whole dying process. How do we want to spend the weeks and often months, when we are no longer able to do basic activities without assistance?
 
Preparing for a time when you are unable to speak for yourself or are incapable of making health care decisions, is called Advance Care Planning. ACP is composed of 2 parts. The first step is to designate a person or persons called a Substitute Decision Maker, as the one to speak on your behalf. The ideal people to choose are the ones who will respect your wishes. The second, and often neglected part, is to start the conversation with them about what your wishes would be in an acute life threatening situation such as a stroke, or a more insidious one such as Alzheimer’s disease. You can download the appropriate document called a Power of Attorney for Personal Care, from the Attorney Generals’ website and appoint your Substitute Decision Maker (it does not require a lawyer, only 2 witnesses). You can add in specifics such as Do not use a defibrillator, do not insert a feeding tube or yes give IV antibiotics, but the real work is to start the ongoing conversations you need to have time and time again with your SDM and yourself.
 
What is important to you if you are nearing the end of your life? What are you most afraid of? What are you willing to trade off in the quantity versus quality dynamic? Will there be anyone around to help you in your time of need?
 
Some sobering facts. 10 % of Canadians will die suddenly, which means the rest of us will experience a more prolonged period of diminishing capacity. In one survey, 93% of seniors stated that they preferred to die in their home or current residence, yet the majority of Canadians die in a hospital.
 
And now the good news. Having an Advance Care Plan has been shown to decrease hospital admissions, length of stay and improve family’s and patient satisfaction with care at the end of life.
 
As a family doctor, Palliative Care has always been a part of my “cradle to grave” practice. In my younger years people would ask me, isn’t working with dying patients depressing? I can tell you that is the best part of my practice. Being able to care for someone in their own home, surrounded by loved ones is a rewarding and fulfilling opportunity and I feel privileged to be part of their circle of care. You become intimately involved in all that is going on, the good the bad and the ugly.
 
The good: such as children returning home to care for sick parents, learning things they never knew about family members and themselves. The bad: watching conflict arise amongst individuals who only want what’s best for their loved one, but are unable to put aside their personal differences. And The Ugly: such as the spouse who refuses to accept that their partner is dying and wastes precious time seeking alternate opinions and treatments.
 
We are a death defying society and those actively dying are suffering for it. I have been fortunate to live and work in Addis Ababa, Ethiopia where their attitude to death and dying is completely different. Dying is a part of living. I recently made a house call to a terminal cancer patient, and while she had no family, local children played on the floor of her one room home to keep her company. Neighbours dropped by to offer us coffee as they knew the patient was too weak to make her own. She spent the whole visit thanking us for coming by and at the end blessed each of us.
 
They say is takes a village to raise a child, but what does it take to lower one gently into the ground? Who will be around to care for you when we can no longer care for yourself? What do you need to do now to prepare for the long process of dying? Is there something you need to make right? By the way, if you think that in your final days longstanding conflicts will be resolved, and estranged family members will reunite, in my experience that is a rare occurrence
 
What do you want to say to those you leave behind? Fortunately, there’s an app for that called Record Me now http://www.recordmenow.org. It allows you to use an iphone or computer to record yourself for posterity.
 
How does one even begin thinking about completing an advance care plan? The government has an excellence program called Speak Up Canada. You can visit their website at www.advancecareplanning.ca or google the words Speak up Canada.
 
Did Shimon Peres have an Advance Care Plan? I don’t know. When his son spoke of the difficult decisions they had to make, did they know what their father wanted? I hope they did. As the older sister Evelyn in Woody Allen’s Café Society said: “Live every day like it’s your last, because one day you’ll be right.”
 
Lets hope that doesn’t apply to the Blue Jays.
 
Shanah Tova.

Wed, 22 May 2019 17 Iyyar 5779