Monday, March 21, 2011

End of life care - having a good death

As a hospice volunteer I deal with many different people in various stages of life and death.
It's true, only death and taxes (death with taxes!) are the two things we can count on in life.

In conversations, we talk about death and dying in hushed tones, if at all. We seldom discuss situations open-mindedly except with more distant family members. I have found than my hospice clients tend to talk to daughters-in-law, rather than daughters or sons. There is an honesty and an openness.

One letter-to-the-editor to our local paper was entitled: An enlightened view of dying

It was written in response to this editorial by a staff writer:
Cancer is not a War
This editorial can be summed up in this paragraph:
I propose we wave the white flag on the metaphor. Though I feel it is important for cancer patients and their families to maintain an element of hope and optimism -I am a realist. The statistics don't lie and too many individuals end their lives with a battered attitude, never fully accepting their fate. Read more:

Dying With Dignity - it is possible, if we trust our caregivers and healthcare professionals to treat us with dignity, which includes honesty. I think it important that caregivers and care recipient have an understanding, and communicate well.

The big question, how long do I have?, is one that makes many uncomfortable. And one that is hard to answer. The process of dying is difficult, especially in the face of those who are in denial themselves. We dance around the death bed, without dealing with unresolved issues, grudges we bear, angst we must release.

I remember visiting a client. While I was there, one of her best friends from her childhood visited and said that her friend looked pretty good! I know that she was in denial, speaking of her friend whose body was riddled with cancer, she was weak, unable to eat, and was incontinent. She died a week later.

I'm with the above authors. I don't want to hear false hopes. I want to have realistic hope. I want a *good death.

Too many die in an ER. Too many end up in emergency rooms, facing issues such as abdominal pain dyspnea, pneumonia, malaise, fatigue, pleural effusion, symptoms that can be managed in other settings, with an integrated team approach in which patients and family members are integral parts of the team.

For what do you hope: today, tomorrow, this year?Are you enjoying each day to the fullest, no regrets about tasks incomplete, dreams delayed? Are you loving yourself as much as others love you?

it is important for those who are dying to be encouraged to focus on different hopes. They require facilitation to look for the hopes and dreams and wishes of today, not tomorrow. And to appreciate the dreams and wishes that were fulfilled in other days. An end-of-life review is an important way to appreciate what has gone. No regrets. What was, is in the past. There is the now and the time is now to look at the lessons we've learned since then.

This is a powerful time for joy and love. End-of-Life Care Standards
 are an important aspect of care, as much as determining when the time has come to review.

*A good death is one in which the four dimensions of good death are met:
  1. Physical (pain control, breathing, fatigue, bedsores), 
  2. Spiritual (accepting death, doing a life review, seeing meaning on one's life, finding peace), 
  3. Social (being conscious; communicating with family/friends, careworkers; communicating needs, wishes; sharing thoughts, feelings; having closure; saying farewell; a quiet, private atmosphere) and 
  4. Emotional/psychological needs (accepting help; not being a burden; being peaceful; having self-esteem; enjoying simple pleasure by releasing hope by gaining peace; making choices).

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