Edward T. Creagan MD - Farewell: Vital End-of-Life Questions with Candid Answers from a Leading Palliative and Hospice Physician

PRAISE FOR FAREWELL

Every human deserves dignity and peace in the final chapter of life. Written by a caring physician with experience in palliative care and deep knowledge of the dying process, Farewell is a must-read book that could help each of us personally and also benefit those caring for the terminally ill.

DEEPAK CHOPRA, MD, FACP
Cofounder, Chopra Center for Wellbeing

Where do you go to learn how to make a positive difference when someone you know is dying? Death is shrouded in mystery. The fear of making things worse rather than better keeps many people at a distance when they want to make a meaningful connection. The authors of this excellent book, Farewell, demystify the dying process. You will take away information and insights so that you can be there when someone is dying.

VICKI RACKNER, MD, FACS
Retired Surgeon and Clinical Instructor
University of Washington School of Medicine
Author of Caregiving without Regrets

Dr. Creagan is a compassionate and experienced physician who offers patients and families not just information and knowledge, but, more importantly, a lifetime of wisdom. Skillfully written and full of personal anecdotes, Farewell is an essential guide to helping individuals make wise choices about living, and dying, well.

J. KEITH MANSEL, MD

Professor of Medicine

Director, Palliative and Supportive Care Services

University of Mississippi Medical Center

Knowledge provides a calming power when dealing with end-of-life issues. Farewell respectfully and transparently provides every element individuals and families need to traverse the often complex and always emotional quagmire of death and dying. Farewell will guide, inform, and create a surreal peace for anyone going through the journey for themselves or someone they know. A few tears welled up reading how my brothers passing could have been handled better had I had such a great book as Farewell as a ready resource.

ELAINE C PEREIRA, MA, OTR/L, CDC, CDP
Certified Dementia Practitioner, Speaker, and Caregiver
Author of award-winning book, I Will Never Forget
A Daughters Story of Her Mothers Arduous
and Humorous Journey through Dementia

Dr. Ed Creagan has been a referring physician to the Seasons Hospice for more than twenty years. As well as being a very skilled doctor, his humor and wisdom are an asset to his patients. As Dr. Creagan states in his book, Farewell, he has dedicated his life to death, and the community of Rochester, Minnesota, is thankful for the advocacy he has provided on end-of-life care and the importance of normalizing death as a natural part of life.

BEVERLY HAYNES, BSN, RN
Executive Director, Seasons Hospice

2019 Edward T. Creagan, MD. All rights reserved. Printed in the United States of America. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written permission of the publisher.

Patient privacy: With medical privacy laws, which I deeply respect, and my oath as a physician to maintain privacy, I will introduce you to some of the types of people I see with dreadful diseases. Their stories, a compilation of experience and example, will serve to paint a broad picture of the end of life. Facts and details have been changed, of course, to mask identities, but each patients story remains with me and shapes my growth as a physician and human being.

Medical disclaimer: The information contained in this book is not intended as a substitute for the advice and/or medical care of the readers physician, nor is it meant to discourage or dissuade the reader from seeking the advice of his or her physician. If the reader has any questions concerning the information presented in this book, or its application to his or her particular medical profile or the medical profile of a family member or friend at the end of life, he or she should consult his or her physician and the attending physicians of the ill person. Neither the authors nor the publisher shall be liable or responsible for any loss or damage allegedly arising as a consequence of the readers use or application of any information or suggestions in this book.

This book reflects the individual views and opinions of Edward T. Creagan, MD.

Library of Congress Cataloging Number: 2018952652

Cataloging-in-Publication Data on file with publisher.

Paperback ISBN: 978-0-9916544-8-2

Kindle ISBN: 978-0-9916544-9-9

EPUB ISBN: 978-1-7326404-1-2

Audiobook ISBN: 978-1-7326404-2-9

Write On Ink Publishing

Omaha, Nebraska

(402) 334-2547

Contact the author for speaking engagements and events through the publisher or www.AskDoctorEd.com.

TO THE PATIENTS AND FAMILIES
who have shared their stories of courage,
tenacity, and grace at the end of life.

CONTENTS

I have dedicated my life to death.

For over forty winters at the Mayo Clinic in Rochester, Minnesota, I have been at the bedside with more than 40,000 patient encounters in the last stages of their lives on this earth. Held the hands of family members. Prayed with them. Listened. Answered questions (not all questions had answers, such as these: How long am I going to live? Who will be with me? Will my family forgive me? and Will I have pain?).

This book is about navigating those last days and saying farewell with hope, love, and compassion.

About making end-of-life decisions when Mom or Dad or a loved one cant or wont.

About understanding whats happening in the mind of someone facing their last days, hours, minutes, and moments.

About coming to grips with our own mortality, maybe putting plans in place, living life differently after having held the hand of a loved one who is actively dying.

About giving hope where none seemed possible.

About understanding death from a medical perspective, and much more.

I am trained as an oncologist, a cancer specialist. Heart disease is the leading cause of death, but cancer is the most feared. Patients would rather be told their heart muscle is failing than that they have a mass in their pancreas or liver or lung or breast.

Many cancer patients are cured and go on to live a long and healthy life. Others are not so fortunate. Im sorry to tell this to former Vice President Joe Biden, who was charged with advancing cancer treatment and cure, but the war on cancerbegun with legislation and research funds back in the Nixon administrationremains a multifront battle. Yes, it has seen some exciting progress here and there, but, because cancer comprises many diseases, we will continue to fight it for a very long time.

When we cancer doctorsand especially in my practice at Mayo Clinicsee patients with far-advanced disease, the treatment we offer them is often comfort and dignity and choice and hope. No magic bullets. No miracle potions.

As our patients face their own death, we extend our care to them in practices called palliative care (a medical specialty known for managing symptoms and providing comfort measures) and hospice (for patients who are assessed to have just months to live and are not pursuing treatment for their terminal illness). Of course, we are happily surprised when someone rallies for reasons beyond the understanding of modern medicine, but often the road leads to a bedside and family members gathered around, consoling, cajoling, and saying farewell.

I have board certification in internal medicine, medical oncology, and palliative and hospice medicine. I was the first Mayo Clinic doctor certified in this specialty, and I am grateful to the thousands of patients and their families and loved ones who allowed me to take their final journeys with them. I have now stepped away from active clinical practice and leave as my legacy this book that sums up my years of experience with families just like yours.