As an RN on a palliative care team, I often am consulted to help families who are making end-of-life decisions. One particular patient and family offer a great example of these important conversations. The 87-year-old patient, who was diagnosed with anoxic brain injury, had been in the hospital for two weeks before palliative care was discussed.

"The doctor met with us," a family member said to me. "He said we should think about withdrawing care. What does that mean?"

I asked the family what the physician had told them about their loved one's condition. "He said she won't get better, that he has done all he can; that we should stop everything."

I explained to them in detail the process of using comfort measures only. "We will give her a little pain medicine, no more than she needs," I said. "We can untie her hands (which were restrained to keep the patient from accidentally extubating herself) and let her take that mask off if she wants, too. We won't worry about her saturations — won't even watch it. We can give her a tiny bit of something she likes to eat, maybe ice cream?

"We won't worry about a swallow study; we aren't forcing her to eat a lot of food, just as much as she wants. We will give her little swabs of water and, of course, continue to turn her and keep her clean. We won't withdraw care, we will increase it. We will only withdraw artificial life support, the things she said she doesn't want, according to her living will."

"I wondered what he meant by withdrawing care," said the daughter. "I thought, 'Will they put her in a corner and let her die?'"

I reassured them, "We are honored to care for your mother at this time, and we will take very good care of her. We will increase our nursing care and only decrease the machines."

They ask the right questions; questions we expect. "Will she die right away once the breathing machine is stopped?"

"We don't know. A higher power decides when we die; we can only decide to follow her wishes, to make her comfortable."

"I am worried that she will gasp for air and suffer."

"She will not suffer; we will treat her symptoms very carefully."

"If the monitor is turned off, how will we know when she dies?"

"We will check her very frequently, and if you need us we will come in right away. We will listen with a stethoscope for heart and lung sounds. We will know."

"What shall we do while we are waiting?"

"Why don't you tell her a story? Talk about the things she was good at and the things that she wasn't. Talk about your memories."

Finally I ask them, "Are there any religious or cultural observances with which we can help?"

"Yes, can we have the chaplain come and pray with us? Then we will be ready."

What I remember most often are a family's emotions — grief, guilt, understanding and acceptance. I want them to know all their options. I want them to articulate the patient's preferences and not to feel guilty about their decision. Families want to know how long the patient will take to die. I tell them only God knows that, but we will continue to take very good care of their loved one as long as he or she is with us.

Jeanette R. Stevens, RN, BSN, CCRN, CHPN, is on the palliative care team at Tampa (Fla.) General Hospital.