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The Wizard of Oz model in palliative care

In the Initiative for Pediatric Palliative Care (IPPC) curriculum under the topic of communication during times of medical crisis and decision-making, inspiration is found in the Wizard of Oz story. One might think it could be the value of "there's no place like home" or perhaps the mistaken idea that doctors are wizards who can magically solve our biggest problems. Instead, the Wizard of Oz story gives us examples of what is needed from those talking with us about life, death and quality of life decisions. From Frank Baum's tale of Oz, we get the role models of the Scarecrow, the Tin Man and the Lion, and we need each one.

When we are in crisis and need to know and understand our options, we need someone smart, someone with brains, like the Scarecrow. It's a complicated world and considerations in a medical crisis can be quite complex. In these situations, we need someone who is really smart and well-informed about all the options that fit our particular situation. We need someone who not only understands the territory well, but who can break it down and explain it in ways that make sense to us and yet does not over simplify. When faced with a crossroads in our healthcare and in our lives, we need a smart Scarecrow to guide us through the choices in front of us.

While we need someone who is bright and thoughtful at these healthcare decision points, we also need someone with heart like the Tin Man. This is scary and upsetting stuff and we need the support and empathy of someone who cares. The Tin Man may have been hard on the outside, but that stiff exterior could not hide the large and warm heart inside-we could see it in his eyes and hear it in his voice. When facing some of life's most difficult decisions about ourselves or our family, we need not just the correct information, we need compassion. The Tin Man gets how painful this place can be and finds ways to offer support so we don't feel as alone on whatever path we take.

But it's not just brains and heart that we need in this dark and often lonely place; we need someone with courage like the Lion. Death is scary for most of us and the process of dying can be just as scary. This is not a job for the faint-hearted. And while we need someone who understands the situation very well and offers compassion and empathy, we also need someone brave enough to speak the truth about what we are facing and what options actually exist for us. It's not just enough to know and it's not just enough to care. In fact, caring can sometimes work against the goal of honesty when the reality of a situation is very difficult. Yet truth delivered without compassion may be experienced as an aggressive act and in this vulnerable state we do not need the experience of being bullied or abused. We need someone with the fortitude to be with us and stay with us in the turning of the pathway in the deep woods. We need courage and strength embodied by the Lion.

It's a lot to ask, really - deep and broad understanding, deep and vulnerable caring, deep and steadfast courage. When we're in the deep waters or in the forest deep, instead of a "wizard", we need the qualities found in those three traveling companions on the road in the land of Oz.

 

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