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Susquehanna Life

The Elephant in the Room

Mar 12, 2015 12:41PM ● By Erica Shames

Jim Desiderati, a nurse specialist with Geisinger’s Hematology/Oncology clinic, was employed as a hospice nurse for 11 years. Often, according to his wife Cindy Moyer, he would come home with disturbing news. 

“He was in someone’s home to admit a hospice patient to service and either the family or the patient had no experience with hospice – some didn’t even know it was a hospice admission. Often, he said he had to address the ‘elephant in the room.’”

Moyer, a social worker, heard about elephants in the room so many times, she decided to address it. Elephant in the Room ( is a guide to help people start the difficult conversations that must accompany terminal illness and end of life issues.

“Elephant in the room helps people begin these difficult conversations in a way that’s not frightening, that maybe adds a little levity to the situation, so they can approach it and not be so fearful of it,” stressed Moyer.

The guide consists of 96 cards, shaped like elephant footprints, divided into four categories: values and beliefs; people and places; definitions and resources; and complex care. “To start a conversation about the moral compass and belief system you employ to make decisions, you might start with the category values and beliefs to consider what your spirituality or religion says about death.”

On the other hand, definitions and resources cards define hospice care and palliative care, and point people towards resources in their communities, such as home health agencies or home care services, via national Web site portals.  “Where you want to receive your healthcare?” asked Moyer. “Do you want to stay at home or do you want to be in a nursing home? Who do you want providing the care? Do you think your daughter is going to be able to help bathe and groom you or is she uncomfortable doing that?”

And, lastly, complex care questions are scenarios Cindy and Jim picked from their experiences both as nurse and social worker that involve what-happens-when decisions. “Say you’ve had Alzheimer’s for 10 years and you can no longer swallow food. Do you want a feeding tube? It’s meant to address very complex scenarios. Eventually, people have to make those tough decisions.”

The deck of cards is the result of Cindy and Jim’s experiences at work and in their personal lives with their loved ones. “We offer a base of information from both work and personal interests,” said Moyer. “I think that lends some credibility for people going through a similar situation – to have someone who’s walked that path.”

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