Advanced directives: bringing life to conversations on death

Published: August 13, 2015


For many Wake Divinity students the summer is an ideal time to delve into internships that provide significant and meaningful opportunities for their vocational discernment and formation as future religious leaders. From working in hospice and palliative care, ministries supporting the imprisoned, homeless and burdened, assisting with art and restoration efforts of a living museum, to being immersed into the fullness of congregational life in a diverse array of churches, Wake Divinity students are dispersing across the country. This summer the Unfolding blog has featured weekly posts from several students who have participated in an internship. Each story has spoken to their expectations and experiences. This will be the last entry of this year’s summer internship blog series.

maria-nkonge-blog2Summer time is a rejuvenating time for graduate students.  It is the time when we rebuild our mentally-taxed minds from the school year by engaging in summer projects that uplift us and reaffirm why we work so hard.  This summer, I had the pleasure of interning at the Downtown Health Plaza (“DHP”), an outpatient clinic of Wake Forest Baptist Health (“Baptist Hospital”) that provides medical services to lower income individuals in the Winston-Salem area.  I set out to help lay the foundation of an Advance Directives Clinic that would be incorporated into the Pro Bono Project at the School of Law.  Advance Directives are legal statements that let others know what type of healthcare treatments you want if you become too sick to speak for yourself.  Having participated in the current Advance Directives projects at Novant Health and Baptist Hospital, and having enjoyed assisting patients with completing their Health Care Power of Attorneys (“HCPOA”) and Living Wills, I knew I had my work cut out for me as I started here.

So much time, energy, and patience go into building a program from the ground up.  From what I have gathered over the past year, end-of-life planning is a delicate topic for so many because, as one patient put it, “Talking about my death makes death more real.”  Asking a patient to think of two people, who can act as their health care agent, to make healthcare decisions on their behalf if they are unable to communicate themselves, almost feels like asking a person to decide which family member they love the most.  It is a patient process—literally and figuratively—to say the least.  Choosing those agents and deciding whether you would like to remain on life support if in an irreversible coma are topics I discuss daily.  I believe in their importance because I know the peace of mind one gets in knowing they chose who will speak and be there for them in their hardest hour.

HCPOAs are wonderful documents that begin conversations with loved ones.  They allow otherwise healthy adults to discuss what they would like to happen should an accident occur that temporarily impairs their ability to communicate.  These accidents range from heat exhaustion to recoverable drownings, motor vehicle accidents to in-surgery complications.  By discussing with a family member or friend their wishes, a patient can personally select who is likely to uphold their wishes if necessary.  Similarly, a Living Will allows a patient to decide for himself or herself whether to remain on life-sustaining treatments in 3 situations: (1) an incurable disease with a limited time to live; (2) a coma from which they are unlikely to ever recover; or (3) advanced dementia resulting in significant loss in cognitive reasoning.  The primary reason I enjoy explaining the benefits of an HCPOA and Living Will is to not only return some of the power of certainty to the patient, but to protect their families from arguing over the hospitalized person’s care when they are encountering sudden grief and fear.

maria-nkonge-blog1An outstanding group of individuals in the Bioethics Department compressed the once 17-page North Carolina Advance Directive into a reader-friendly 3 page document—one page for the HCPOA, one page for the Living Will, and one page for the witness signatures and notary seal.  It contains an additional 2-3 pages of bulleted information about what each document authorizes and has done wonders for medical professionals hoping to advise their patients on the matter.  The conversations I’ve had with patients this summer have definitely reaffirmed my desire to continue this project into the school year.  As a Law student, I had to make sure I addressed specific information necessary to begin working on the paperwork.  As a Divinity student, I wanted to know the stories that led each person to the station I set up at the entrance.

Some people were led to my Advance Directives station out of curiosity.  They were unfamiliar with these documents and wanted to gain some information about their benefits.  Others came over because they were planning to do so with their doctor or lawyer and were excited about the free service being offered at DHP.  And some had stories of families being torn apart in waiting areas, hospital hallways, and bedsides as they struggled with their family member’s last wishes.  What I found was conversations of illness and death were happening every day in the lives of the DHP’s patients.  I hope that by highlighting the benefits of such conversations, the stigma of “death talk” can leave the community.

I am definitely grateful for the support I received from the School of Divinity, the School of Law, and the Downtown Health Plaza, along with countless individuals, who all made the dream of this Clinic a reality that is set to begin this fall.  I look forward to continuing my work at the DHP during the school year and bringing more life to this awesome program!

maria-nkonge-headshot-blogMaria Nkonge

Maria is currently enrolled as a joint degree student with the School of Law and holds a Bachelor’s degree in International Studies from the University of North Carolina at Chapel Hill.  After graduation, she hopes to have a long career as a trial attorney, while continuing her work as a hospital volunteer and chaplain.  In her free time, Maria enjoys snorkeling, hiking, Frisbee with her dog, and cooking with family and friends.