Tuesday, November 2, 2010

Euphemisms for death

'Circling the drain'
'Tell them not to buy any green bananas'
'Classic case of FTD' (Failure to Die)

GOMER = Get Out of My Emergency Room, i.e. typically elderly, demented patients with chronic, complex and usually incurable conditions.

As my friend, the Emergency Room Nurse says, a GOMER is the nonverbal, contractured, 80-something from the nursing home down the road, with Alzheimer’s dementia and multiple strokes, who’s come for the fifth time in three months in for aspiration pneumonia/urinary tract infection/blocked...

I just heard a great show, By Dr. Brian, White Coat Black Art. When Your Life is Circling the Drain.

Dr. Brian talks about Canada's Fear of Death. It is not true of all cultures. But it garners less than an hour in the training of some physicians, he tells us.
Doctors are not trained to handle it. Medical staff, as with all professions, use Black Humour
to cope with the stress of caring for those who cannot be cured.
Palliative care is important for those who want a quality of life.
Roger's House staff and parents of 'J'
 Teams of medical specialists, social workers, massage therapists, who work with the patient and family.

Hospices are increasing in number in Ontario.
For example:

Hear the story of Margaret Anderson, a woman who used the bitter lessons from her husband Ian Anderson's death to create Ontario's first cancer hospice.  It's called Ian Anderson House,  and it's a hospice with six bed that has been home to 800 people at the end of life and their families.

I was privileged to meet those who run Roger's House, a respite hospice for children in CHEO, named after Roger NeilsonA Tribute to Roger Neilson

CHEO Palliative Care Outreach Team - Roger's House
Marion Rattray, Charge nurse. Dr. Christina Vadeboncoeur, nurses Megan Sloan & Nancy Graham, and Karen Moreau, Patient Service Worker.
Fabulous staff. Great organization.

Well organized, with an integrated approach. Families burn out caring for ill children. This is a place where they can get treatment, space, time and a team approach to the care of palliative children.

A new day hospice is opening in Perth in the new year. I am excited to be a part of it.
The principles of palliative care are the same for young or old, whether urban or in Hospice in Rural America.
  • Family-centred care
  • Therapeutic relationships (lots of talking)
  • Continuity of staff
  • Communication between staff, patient and family
  • Ethical considerations that determine quality of life
It is a total approach that integrates symptom management, respite, and includes follow through in terms of illness, death and bereavement, including debriefing for staff.

Concerns include comfort measures, respect for appetite, treatment and prevention of psychosocial issues for family and patient. Treatment for pain, anxiety, skin comfort and skin integrity as mobility becomes an issue for patients.

What I learned teaching, and what was reiterated in the workshop, were these social-emotional principles for working with a client:
  1. Never repeat anything twice.
  2. Identify emotions in the patient and walk away.
  3. Tools used at Roger House
  4. Be firm and fair
As many of us know who work with dementia clients, it is easy to sucked into pity, rather than keeping on the firm and fair high road. You risk your social-emotional well-being as a caregiver as you end up working with what can become a demanding, anxious, acting out patient. 
Most of us have anxiety about death, and experience existential suffering as you deal with your mortality. 

Roger's House incorporates memory making and legacy building, as they honour the life of clients. A memory box, scrap booking, and expressive arts are excellent ways to begin the pre-grieving, and the bereavement process.

Hospices on-line

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