Magnolia Cardona & Ebony Lewis - When the time comes: stories from the end of life

When the Time Comes is a collection of short true stories written by a doctor and a nurse based on contributions from older patients, their families, informal caregivers, and other health professionals who know what the end looks like and what we can learn from it. The book is written in plain English to raise awareness among the general public and to normalise talk about death.

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About the Book

Death is still a taboo subject, we don’t like to think about it let alone talk about it and yet, the one certainty that binds us all as humans is that we will each die. How we die is more within our control than we may be aware, but it means we have to bring ourselves to address this grim topic in the prime of our health. The importance of having an open conversation with family and healthcare professionals about our preferences for care in case we lose the physical or mental ability to make decisions cannot be over-emphasised.

“Whether you are a son or daughter looking after a parent with dementia, or the spouse of someone dying of cancer or chronic lung disease or progressive heart failure, or whether you are being asked by a critical care specialist whether they should resuscitate your loved one should their heart stop while they are in hospital, the trajectory is less painful if you have had the opportunity to discuss in advance what treatments you or your loved ones consider unacceptable”, says Dr Magnolia Cardona, an associate professor of health services research and advocate for the rights of older people to not endure unwarranted overtreatment. “It is never too early to hold the discussion, and soon after a diagnosis could be the first opportunity. There are several chances along the way to talk some more, to change your mind, to clarify your thoughts”

The preparation when death is anticipated and inevitable includes physical, psychological and social support. Geriatric nurse Ebony Lewis -a co-author and frailty expert- believes “It is a privilege to help patients through the process by guiding them about treatment options, benefits and potential harms. It is also rewarding to honour their preferences for place of death as far as possible. That’s why formalising an advance health directive or at least a statement of choices is so important.”

All the stories in the book carry a message about the benefits of planning for future critical illness, and the potential distress that comes for patients and families from avoiding the discussion on overtreatment. Some of the stories are uplifting and full of hope; others leave us thinking of how we could have improved the experience.

About the Authors:

Dr Magnolia Cardona, PhD, MBBS, MPH, is a former GP, public health practitioner and current associate professor of health services research. She is a passionate advocate for the rights of older people dying of natural causes to not be over-treated with low-value care and instead have a dignifying end of life through aligning treatments with patients’ values and planning in advance. Her controversial research with patients, families and clinicians on this sensitive topic has attracted international media attention. Her goal is to improve the natural end-of-life experience for all. 

Nurse Ebony Lewis, BN, MIPH, is experienced in emergency and geriatrics nursing, a skills combination that has made her highly aware of the needs of older people to be treated compassionately at a place of their choice, including their own home rather than in the emergency department environment or the intensive care unit. She loves talking to older patients, visiting them at home for their health assessments and helping them express their values and preferences before they become critically ill. She is now undertaking her PhD studies on frailty.