Care at the Time of Death

req_read · Sep 12, 2007

Lest someone misconstrue, let me clarify…

Leslie is absolutely correct in saying that symptom control is essential. It is, in fact, the first, necessary step. It is like starting the engine of your car. If you don’t start the engine, you aren’t going anywhere. But after the engine is started, the point is to go somewhere. After the symptoms are controlled, the point is to get the work of dying process done… which is the harvesting of the fruit of one’s life experiences… to ‘real-ize’ (as in- ‘make real’) one’s life.

To underscore the point I was trying to make in the previous post I will expound a bit on one of the stories from my 3rd book; i.e. the one about my Native American colleague (a CNA with whom I once worked.)

One of her duties was to take the dirty laundry to the basement every evening… but she would not go alone. You see, she had to go past the morgue to get to the laundry. Everyone knew this about her, and everyone accepted it… but after getting to know her I asked her, “Why?” By that time she trusted me… that I would not think she was crazy (perhaps because I was crazy too?) Anyway, she told me she could see dead people and that it scared her. She told me that Indians can see such things, and that white people can too. It’s just that white people block it out. When white people see (for example) a dead guy, they look away, blink and rub their eyes, then look back and sure enough… it’s gone. We (white people) don’t want to see dead people, so we don’t. It would scare us too much. It would upset our orderly little interpretation of reality. We like things neat and simple and above all, NOT scary!

My Indian friend accepted the emotion (being scared) and therefore her reality was more expansive than ours… or at least, until we die.

Even white people begin to see things when they die. Why? Probably because their 5 physical senses are being degraded. When sensory perception fades away, what’s left? Extrasensory perception of course. The perceptions that we block out for most of our lives because they are too scary suddenly become the only perceptions we have left. Ironic aye?

So when hospice pts report seeing things we cannot and are frightened by it, that is perfectly normal and valid… both the seeing and the feeling. At that point the nurse should reassure the pt… but NOT by trying to convince the pt his/her perceptions are false; e.g. hallucination etc. When the pt says he is having pain you assume it is real and treat it. When the pt says he sees a dead guy… or a spirit… assume it is “real” and support the pt.

We make our reality smaller, simpler and more manageable because we cannot handle the emotion intrinsic to a larger reality. Then we puff out our chests, pat ourselves on the back and proudly declare this is so because we are more intelligent and realistic than Indians… plus we’re Christians.

Ain’t life a hoot?

Michael

Allow Mystery · Sep 12, 2007

Thanks Michael,

Life is a hoot, and so is death. Allowing for a good life and a good death is our responsibility, and we may best meet this responsibility

by being in peace, first with ourself, and then with others. We may be in peace with others by being nonjudgemental and allowing for that relationship which Leslie so eloquently addressed in her last posting here.

req_read · Sep 14, 2007

Allow Mystery…

The subject matter was directed towards the nature of reality, how it is created, what possible role we may play in that, how emotion may be involved and how dying process might provide a glimpse into the inner workings of all the above. Your point is? Judgmentalism? Could you be more specific?

Michael

sharona97, BSN, RN · Sep 14, 2007

Oh Dear Master,

I am nothing but a twig on your ever growing tree. Hi, my name is Sheri and I am so glad I ventured into this specalty forum.

Thank you for your wonderful words of wisdom. I related strongly to one of your topics about the energy patients have, living or dying. Why? Because one of my first instructors asked the class,"where does all that energy and electricity go after a patient has died. I've always pondered that question through out the years until today. You gave me an AH HA moment.

Secondly, I agree with "thinking out of the box" theory you have with academia. I was misdiagnosed with pertussis during an epidemic in my home town. It took 4 months for Dr. Delightful to move me on. Yes I could have subjected myself to a second opinion: I choose instead to work w/mask on mouth,despite the jeering of my coworkers, and it was then I was asked to see his partner. My spirit soared when I read that nurses want to care, bottom line. Thank you for that.

And then there is George, which for obvious reasons I won't go any farther, you said your view for me.

Lastly, I wish many posters could read your posts and end the back stabbing of what constitutes a higher learning without the discord to their lesser educated co-workers.

I wish you well in all of your wisdom.

req_read · Sep 14, 2007

sharona97...

Thanks... I think. Who is George?

Michael

sharona97, BSN, RN · Sep 14, 2007

Michael,

George Bush and your quaint statements about his past drinking, turning to religion,and did it really matter he quit the beer. I'm assuming because of the behaviour and statements. Anyway.....

I took the time to read the last 6 pages of postings. I can now understand so much more,yet know it's skimming the top for me on Care at the Time of Death. I am not a hospice nurse,although;I am intrigued.

I'd like to share with you what brought me to this forum. One of my cousins recently died from pancreatic cancer. It was not a sudden death and I am now convinced he was able to die well. (oxymoron?) Anyway, I received a phone call from one of his sons to come to the hospital as Jim wanted to speak to me. I was amazed. He was quite a bit older than I and how did he remeber me. Through my father. My father passed at age 56 suddenly. So I hopped in the car for the 1 hour drive and continually thought what our conversation might entail....

Before I left the house I grabbed a blessed cross I've had forever. When I arrived at the hospital there was standing room only. (Jim was the 1st of 12 children) I was asked to go into his room and I took his hand and having to bend way over him as he barely whispered, told him I am here.

He needed to tell me that my father says hi and he misses me. Jim offered to tell my father hello and assure him I was alright. Now there is some enlightenment for me on the conversations between Leslie and yourself.

So that's it folks. I plan to keep reading this forum (or is it lurking), if anything to learn how grateful we all are or should be and for me it took these posts to open my eyes to reality.

Thanks Again,

Sheri

req_read · Sep 15, 2007

Sharona97…

Oh, okay. I get it now. That George.

As far as addiction is concerned…

One cannot study philosophy or human behavior without studying emotion. And one cannot study emotion without studying addiction.

But that is a subject too big for a post here.

That was nice for your cousin to pass on a message from your father. That must have made you feel good.

For people who spend time with the dying, what we usually call “paranormal” becomes increasingly normal. Not that it becomes blasé or ceases to amaze, but eventually it does cease to surprise.

Michael

leslie :-D · Sep 15, 2007

For people who spend time with the dying, what we usually call "paranormal" becomes increasingly normal. Not that it becomes blasé or ceases to amaze, but eventually it does cease to surprise.
Michael

and what is considered increasingly normal, is often implemented into our plan of care.

i always ask my pt, who they look forward to seeing when they die.

as systems progressively deteriorate, and i notice changes in ms, i want to know if they have seen or talked with their deceased loved one(s).

most often, they do....even when they struggle to explain it.

and those who do not, do not seem the least bit disturbed that i asked.

it is often the last 1-2 days, is when spiritual focus supercedes any other type of care.

leslie

sharona97, BSN, RN · Sep 15, 2007

Thank you, thank you, thank you,

Michael and Leslie I appreciate all the information in your posts and replys to me. My heart strings have the feeling of being tugged.....I am intrigued as I have said before. I will continue to subscribe to this post, I have a strong feeling this is where I need to be right now while learning.

Sheri

req_read · Sep 16, 2007

Leslie…

My experiences (when I was still working directly with pt/fams) were similar to yours.

I remember the first time I asked a dying person such a question. Since it was my first time I was rather clumsy about it. It was not something I planned to do… it just sort of happened. I was talking to the pt and suddenly I blurted out, “So, have you seen the next world yet?” To my surprise he calmly replied, “Yes.” After that I began to realize that dying people “seeing” where they are going and “seeing” dead people is really quite normal and natural, although for lots of them, talking about it to “living” people is difficult. “Living” people are loaded down with prejudices and are quick to label dying people as senile, hallucinating, over-medicated etc., etc. So for the most part, dying people keep quiet. However, when someone who actually understands what they are experiencing (like you, Leslie) asks them about what they “see,” they are usually relieved and willing to share.

This sort of thing is invaluable. Speaking with people who can actually “see” beyond this world is valuable beyond description… and the fact that we don’t do it routinely is wasteful beyond description.

Thanks Leslie. BIG hug.

You too Sheri.

Michael

MQ Edna · Sep 16, 2007

I am planning to take an RN refresher course soon and then apply for a hospice nursing position. I recently shadowed a hospice nurse who said she'd love to help train me and that I should "go for it" :). I've been a nurse since '77 but after a year and a half of hospital charge nurse on nights (24 pts with only an aid or an LPN, not both, to help me) I was ready for my dream job which was, at that time, housewife and mother. We home schooled our children so now that they are all out of the nest I am feeling called by my Lord and Savior to do for others what was done for my father when he passed away from mesothelioma in a hospice back in '82. He was able to live his last days w/o pain and his hospice nurse gave him a little coffee ice-cream (his fav) and later said, "I believe they go better with a little something on their stomach."What I wanted to add of my 2 cents to this thread is this: Could the reason (or at least "a" reason) so many people appear to deny the supernatural and the passing on to eternal life be because they are being taught the theory of evolution to be "fact" in the public school system? If you believe you came from sludge (primordial ooze) and you will return to that same state after death with no deity behind it nor a purpose for it all then it would make sense to try and find some excuse like hallucinations to rationalize away the "phenomenon" many dying people seem to experience.

leslie :-D · Sep 16, 2007

Could the reason (or at least "a" reason) so many people appear to deny the supernatural and the passing on to eternal life be because they are being taught the theory of evolution to be "fact" in the public school system? If you believe you came from sludge (primordial ooze) and you will return to that same state after death with no deity behind it nor a purpose for it all then it would make sense to try and find some excuse like hallucinations to rationalize away the "phenomenon" many dying people seem to experience.

irishpooh, i just do not know the answer to your question.

spiritual phenomena has certainly been discussed to great depths, but only among a few contributors.

there are too many hospice nurses we haven't heard from.

why doesn't anyone like to talk about spiritual events?

i honestly don't think that the theory of evolution has been taught in many school systems.

but i do think that med and nsg schools, have taught their best attempts of eol care, and how it manifests.

it's a feasible theory to state that multi-organ failure can/will cause hallucinations, as the brain shuts down.

or, if there is ca, then it has likely has mets to the brain.

in other words, our schooling teaches us to find something palpable, something tangible.

that is why "terminal agitation" is r/t a sequelae of insults, yet i've never heard it to be equated with spiritual distress.

and so, the predictable doses of haldol, ativan are administered, to quiet our pts down.

not all pts present with this.

but for those who are vocal, restless, agitated....it will benefit the pt tremendously, to try and discovery "why".

but meds are so much more convenient.

to clarify, i totally support the use of meds.

but i do not believe in trying to quiet a pt when they have something that needs to be said.

but we're a quick-fix society.

whatever works...as long as it's easy and effective.

so, who knows why spirituality is seemingly so repressed in eol care?

certainly, religion is not.

an effective chaplain will address religious and spiritual concerns.

a hospice nurse who isn't afraid to "go there", is equally, if not more, impactful when sharing these visions.

it's a fascinating journey to take w/your pt.

if you do go into hospice, please, take their hand and go for the ride.

it is unlike any other experience you've encountered as a nurse.

best of everything.

leslie