If you need to have a discussion about end-of-life decisions.

The good news is that your narrator has probably already made his decisions about end-of-life care, filed the appropriate paperwork with his doctors and hospitals, and is, in general, satisfied and prepared for the coming years. However, what happens when you disagree with some of his decisions? Navigating the gray areas surrounding end-of-life issues can lead to fruitful conversations, but only if you conduct them in a way that lets your narrator express himself and his wishes.

Raul had outlined his end-of-life wishes, and distributed a copy of his living will to each of his children. Three of the four filed it away for later reference, but Perla took the time to read it to the end, and she wasn’t happy with what she found. “Dad, why did you file a Do Not Resuscitate order already? You’re in great health! Why wouldn’t you want them to save you if you had a heart attack or a stroke? “ “When it’s your time to go, it’s your time to go,” he said simply. “And I miss your mother. I don’t see the point of prolonging life just so I can spend more years alone.”

Perla took a deep breath. “Dad, a DNR is a really serious decision, and not one you should make in a state of grief. Can we sit down and talk about this next week sometime? I just want to make sure I really understand where you’re coming from and what your reasons are. “ Raul agreed to set aside time to talk to Perla in the next week. In the meantime, Perla did research on grief, spousal loss, and grief counselors so she could help her dad find resources in the community. She hoped that, in time, they’d be able to understand each other’s concerns and reach a consensus.

If they are in denial or ashamed of their condition.

Because they hate drama and conflict, narrators may tend to downplay their illnesses and the seriousness of their conditions, especially in cases of especially severe disease. Their natural desire to protect others from emotional harm and to work through problems on their own can lead to an illusion of calm acceptance, even when they are suffering.

Brenda noticed that Sally, her mother, seemed to have more appointments these days. She was more tired, too, but when Brenda asked she said “Everything is fine. I’m just a little under the weather. The doctor says it’s no big deal. He didn’t even prescribe any medications or anything.” Sally’s hands, always steady in the past, shook as she poured the coffee. It was as if the pot was too heavy for her.

“May I come along to your next appointment, Mom?” Brenda asked. “I don’t want you to worry or wear yourself out for me,” Sally replied. “I know. But I want to be able to help you, and I like to be a part of what’s going on with your health,” Brenda said. Sally relented and explained that she had been diagnosed with Indolent Non-Hodgkin’s Lymphoma. She didn’t have the energy or resilience she used to, but because the disease was progressing slowly, at this point the doctor was OK with a wait and see approach. After Sally opened up, Brenda was able to arrange for extra help and meals, and to help her mom navigate her appointments.

If you think they need to see a specialist.

The narrator’s tendency to avoid conflict and prioritize other people’s feelings over their own well-being can make them reluctant to seek out new physicians or to change doctors when their current one isn’t working. Because they don’t want to make their doctor feel bad about inadequate care, they may stay with a generalist long after the health issues suggest that it’s time for a specialist’s intervention. The decision to switch to a specialist may be a long and agonizing one. As a loved one, you can help smooth the transition and help them find a specialist who will match their needs.

Kwansimah had diabetes, but was letting her family physician oversee her care. She’d had the same doctor for nearly 40 years, and he’d watched all of her children grow up. Adansi understood his mother’s love and respect for their family doctor, but felt that Dr. Jones didn’t have the time or expertise to manage her mother’s condition. He didn’t try to change Kwansimah’s unhealthy habits. She needed to see an endocrinologist, not a family doctor.

Adansi knew that if he tried to persuade his mother by listing Dr. Jones’ faults, she’d feel defensive and, even if she promised to change doctors, would continue to see Dr. Jones for her care out of loyalty. He needed to approach the problem from a different perspective. “Mom, don’t you think your diabetes is getting to be a bit much for Dr. Jones? He’s a great doctor, but it’s kind of unfair to him when you treat him like a specialist. My friend sees this great endocrinologist who focuses on diabetes. It might be easier on Dr. Jones if you saw him as your GP, but let someone who manages diabetes all the time oversee your care.” Once Kwansimah could see that visiting a specialist was neither being disloyal to Dr. Jones nor questioning his abilities, she was willing to visit the endocrinologist for extra help in getting her disease under control.

If you think they’re having problems with their medications.

Narrators hate being the center of attention, bothering people, or causing a fuss. This low-drama personality is great when they’re navigating family and workplace issues or helping out around the community. It can be a liability in the instances where they might need to be heard and make a fuss, like when their medications are causing scary side effects. If your loved one is a narrator, you may have to act as an advocate when a medicine is a bad choice for your loved one.

When Ryota arrived at his father’s house one afternoon, he was surprised to find the normally active Takumi sitting in a chair and staring off into space. “Dad, what’s up? Why aren’t you in the garden or in your studio or something?” “I’m just so tired. Every muscle aches and I can’t get up out of this chair. It’s almost like the flu, but… it doesn’t quite feel like the flu. I went to the doctor Wednesday. Probably just have to get used to the new medicine he prescribed. It’s one of those statin things. He said there might be a few mild side effects. I’m just being a wimp, I guess.”

“Dad, it’s really great that you don’t want to bug your doctor,” Ryota said carefully. “But maybe we should double check to make sure these side effects are OK with him? They sound a little scary.” “I don’t want to bother him on the weekend,” Takumi said. “I don’t mind waiting until Monday.” “Maybe we should just call and leave a message and see what he says,” Ryota said. “He’d be hurt if he thought you were afraid to bother him over something like this.” Ever careful of other people’s feelings, Takumi called, and left a message. His doctor called back within an hour telling him to stop taking the new medications and to come in first thing Monday morning for a more thorough evaluation. Ryota could tell his dad was relieved about the outcome.

If you think they don’t understand their diagnosis or aren’t following doctor’s instructions.

Narrators are natural rule-followers. They hate to disappoint people, they want to see things done right, and they thoroughly research all of their prescriptions and diagnoses. On the one hand, this makes them great patients—they’ll follow their doctor’s orders and hate to feel like they’ve let medical providers down. On the other hand, this means that when they aren’t dealing well with a diagnosis, the problems can often run deeper than simply chafing at restrictions.

Leena and Rawan usually had lunch together at least once a week. Over the last few weeks, Leena noticed that her mother had skipped long-time favorites like salad and green beans. Instead, she was eating nothing but meat and potatoes. “Mom, are you on some strange new diet?” Leena asked. “This isn’t what you usually like to eat.” Rawan sighed. “It’s awful,” she said. “But I’m on this new blood thinner, and the doctor said I am not allowed to eat any vegetables. So I’m not. But I feel awful. But he said if I eat vegetables, I could bleed to death and die.” She poked at her food and frowned.

“I’m pretty sure that can’t be right, Mom,” Leena replied. She whipped out her phone and searched for vegetables and blood thinners. She pulled up a few reliable medical sites and showed them to her mother. “It looks like he probably told you to avoid certain leafy greens,” Leena said. “So, let’s double check, but it sounds like you can even have salad as long as you skip the kale and the spinach. He’ll probably say that tomatoes, green beans, and even broccoli are also fine!” Her mother’s face lit up with delight. She pulled out her phone and made a call to her pharmacist. “You were right!” she said. “I’m going to ask the waitress to bring me some of that soup they’re serving today and take the potato home for your dad!”

If you think they’re not taking proper care of themselves.

Narrators are fairly quiet, but they have a deep need to help other people. This trait is why they often end up as servant-leaders in community situations. However, they can become so focused on solving the problems of other people that they lose sight of their own needs. In these situations, narrators require an especially gentle approach, so that they can understand their own needs without feeling attacked or pressured.

Goran had spent years working as a plumber. In retirement, he embraced rest. “My body ached every day for 40 years,” he’d tell his son Boris. “Now is my chance to relax.” Boris noticed that his father was becoming increasingly sedentary, and that he often complained of back pain. Research suggested that regular exercise was the answer, but how could he get his father to exercise more without falling into a cycle of nagging and confrontation?

Boris decided to take a more indirect approach. “My back has been killing me,” he told his dad. “Must run in the family,” Goran replied. “But it’s awful that it’s bothering you so young. You should have had a few more good decades.” Boris replied, “My doctor said I should start walking 3 times a week, but I need company. Will you come with me, Dad? Having you along would help keep me on track.” When exercising became about helping his son instead of simply meeting his own needs, Goran made time to walk and to reduce his back pain.

When you think they need extra help.

Narrators pride themselves on being steady, reliable, and helpful. Unfortunately, this means that they’re often reluctant to ask for help or to admit when a situation is getting out of hand. They’re often convinced that the solution to any situation is “I will work harder.” As a friend or family member, you may have to be the one to shine the spotlight on areas where they could benefit from extra support.

Amy’s mother had fallen and broken her hip. Amy had wanted to put her in a skilled care facility, at least temporarily, but her father, a retired doctor, insisted that he was well-equipped to take care of his wife. Zhang insisted that he could handle everything while she recuperated, from preparing her meals to bathing her in bed, and even helping her with her physical therapy. “I used to do surgery,” he informed Amy. “I can do the work of a tech, especially for my own wife.” Amy soon realized that, no matter how much education he had, her dad lacked the strength and stamina to provide the care her mother needed.

Amy knew she had to give her father time to think and plan, or he’d feel attacked. “Dad,” she said, “it would be good to sit down and talk about how things are going with Mom. Maybe next Tuesday? That would give you a chance to think about problems and make a list of anything you might need.” Because her father had the space to think and plan, he was able to come to the discussion with a list of areas where he needed more help.