A patient fidgeted in his chair in a doctor's waiting room. Impatient as always, he was torn between complaining about being kept waiting and a creeping anxiety about what the doctor might tell him. Approaching 60, he had always been healthy, hard-charging and successful. His marriage was still solid, his kids were launched on promising careers, he still excelled at tennis and he had no “financial worries.” There were, however, clouds gathering on his horizon.
For several months, he hadn't felt quite up to par. He was frequently tired, sometimes edgy and having “gut problems.” His initial hope that this would all just go away was fading and, when his urine had turned dark, he caved and called the doctor.
He was in the doctor's office well over the anticipated 15 minutes. When he emerged he felt dazed and, for the first time, deeply afraid. He automatically took his sheaf of test orders and referrals, nodded reflexively when told to “have a nice day” and felt his perfect world collapsing around him.
Within a week, he had been through what seemed like an endless battery of tests and was hospitalized for exploratory abdominal surgery. The verdict was totally ominous: He had cancer of the pancreas, it had started to spread and he would probably be dead in a matter of months.
What to do now? Go to bed and stay there? Commit suicide? Have a last big fling? Pray for a miracle? Go to Mexico for some radical treatment? He could see no way out. He would have to accept his fate.
As his family and associates watched, he rallied and turned his attention to two goals: making every day count and doing all he could to make sure that his life had counted for something. After a few days in deep thought, he picked up the telephone and called his trusted financial advisor.
When the End Is Near
Glen Gresham, one of the authors of this piece, has observed many patients in circumstances similar to the portrait presented above. Unlike a terminal illness for an elderly person who has enjoyed a full life, the case of a person stricken in their prime seems terribly unfair and tragic. Yet, after the shock begins to wear off, most patients acquire a sense of purpose and an almost resigned serenity about their situation. Psychologists and gerontologists suggest that it is the definitive nature of their condition that provides the “calm.” After a lifetime of planning and worrying about unknown liabilities and risks, terminally ill patients know for sure what will happen. That certainty helps them frame their remaining days with clarity and purpose.
The Role of a Financial Advisor
At no other time does the work of a financial advisor have the potential to do so much good. By first supporting the goals and desires of your client — or relative or friend of the patient — you can become a partner in shaping the patient's legacy. You can provide financial leverage for heirs and charitable interests, as well as emotional participation that will bring even greater meaning and purpose to your work with other households.
A Checklist for When Time is Short
- Beneficiary Check-up
Determine who needs providing for and that the necessary support is in place. Reminder: Only about one in four millionaire households have a current estate plan, so revisions are not only likely, they may be substantial. Beneficiaries should be updated and trusts created with parameters matching the patient's concerns and desires.
- End of Life Financial Planning
The trauma of losing a parent — especially in the prime of life — is often accompanied by the “discovery” of multiple loose ends. Business obligations, tax issues, disorganized or missing account statements, forgotten safety deposit boxes and insurance policies all complicate the family's ability to grieve and move on. Accountants, lawyers, advisors and bankers should all be informed immediately and asked to analyze the situation and provide recommendations. All documents and account statements need to be centralized. Safety deposit boxes should be cleaned out to avoid a probate seal. Personal effects should be listed and assigned to heirs to avoid the inevitable squabbles about who deserves what precious family heirlooms. To reduce infighting in the patient's final days, the executor should be provided with all of the information and heirs told that decisions have been made and they will be told at the appropriate time. Hospice, home care or assisted living should be arranged in advance, including the delivery of any necessary medical equipment, like an electric bed, stairway elevator or wheelchair ramp. Decisions about who will supervise the home care, provide transportation to medical treatments and whether relocation for end-of-life care at a facility is required should be made.
- Leaving a Legacy
The amount of financial support left behind pales in comparison to the impact of personal statements, letters and speeches. Never can a person have more impact than when all around them can see what that person has chosen to share in their final days.
- Taking on a Final Project
Perry Gresham (father of Glen, grandfather of Steve) was an eloquent philosopher and gerontologist who became a champion for the elderly in his 70s. His last project was a book about one of our ancestors — a project he had contemplated for many years. Despite the ravages of cancer, his book project helped maintain his physical and mental energy. And he knew that the book would be the final entry on his personal history — and a gift to his family.
Writer's BIO: Stephen D. Gresham is executive vice president of Phoenix Investment Partners.
Glen E. Gresham, M.D., is professor emeritus of rehabilitation medicine at the University at Buffalo, The State University of New York.
