Managing symptoms for a "good death" - page 15

found at nursing 2006: november 2006 volume 36 number 11 pages 58 - 63 managing symptoms for a "good death" marylou kouch aprn, bc, msn contact hours: 2.5* expires: 11/30/2008... Read More

  1. by   tencat
    It is amazing to me how most of the dying I've dealt with see their deceased relatives. I even had one patient who saw his dog he had in childhood. So far every single one has seen someone from the past. I try to validate these experiences for the dying. Interestingly the family sometimes has the most problems dealing with this part of the dying process. Is it real or an illusion? I can't see them (and I wish I could), but I don't doubt that they are very real to the person who is dying. If it's an illusion, does that make it any less real? Hmmm.....
  2. by   req_read
    tencat…

    It has long seemed to me that dying process is unique in that it provides glimpses into the very essence of things… of human beings… and of the very nature of reality. Yet we don’t study it. It is like stumbling onto an ancient text that contains insights into unprocessed, unadulterated truth… but then not even bothering to read it. Most hospice nurses know, on some level, that what they are dealing with is extraordinary. Indeed, that is undoubtedly one of the prime attractions of hospice nursing… the sense of awe and wonder that it inspires. And still the academic world ignores it almost completely.

    When, for example, a dying elderly man “sees” a dog he had as a child what does that mean? That his old dog exists still on some timeless level? Does it mean that his consciousness or point of attention has become unattached to this point in time and gone back to an earlier time? Does it mean that his consciousness is capable of projecting a separate reality onto his own personal screen? Or should we simply fall back into the cozy but simplistic position of accepting the lowest common denominator of possibility recognition and conclude, “It’s the meds. Let’s try turning down the morphine, cranking up the Haldol and see what happens.”

    Incredibly valuable data, observed by hospice nurses virtually every day, is simply ignored by academia. In the article that instigated this thread (I think… it’s been awhile since I read it) there was a reference to a “study” in which statistical data was being compiled regarding how long before actual death patients lost consciousness… which seemed to imply that patients always lose consciousness prior to death, it’s just a question of how long before. Actually, that is not true. Some patients cross over wide awake… and as a function of their choice (as opposed to being evicted by a non-functional body with no choice in the matter.)

    An effective study would also compile data on the nature of the thinking patterns exhibited by dying pts that tend (statistically) to yield long versus short versus no period of unconsciousness prior to actual death.

    The possibilities for areas of in-depth and potentially enlightening inquiry are endless. Yet academia acts almost totally clueless. One can only scratch one’s head and wonder why.

    Actually, I am sure this will change. But when? What will it take to trip that trigger?

    Michael
  3. by   leslie :-D
    i don't think academia will redirect its focus, anytime in the near future.

    there is just too much spiritual, unexplainable phenomena that occurs w/the dying.
    and as long as it remains unexplainable, or an event that science/physics cannot measure and calculate, then the unexplainable will be appeased by haldol.
    that's the bottom line.

    and that is why it is critical for hospice nurses to be their pt's advocates...
    to explore and go for the ride.
    if we don't do it, who will support these people in this extraordinary transition?
    but even as it stands now, (too) many hospice nurses would rather suppress these realities with sedatives/antipsychotics, rather than delve into this dimension of infinite energy.

    the qualifications for hospice nsg, should not be limited to a, b and c criteria.
    i wish that in order to work hospice, one should have to accept and embrace, spiritual events.
    if all hospice workers, observed and reported the extraordinary occurrences, perhaps some credence would be lent to all of us who experience it.

    i can always hope...

    leslie
  4. by   req_read
    Leslie...

    Yea... you may be right. Let's keep hoping and plugging away though.

    Michael
  5. by   Allow Mystery
    Dear Leslie & Michael,
    I'm slowly being dragged along with your insightfulness
    and only wish the 'lightbulb' was brighter. I'm sorry for
    the inference some time ago that "new age" did not belong
    in this post. "New age" is where we are, it's difficult to ignore
    the truth. Experienced Hospice nurses as yourselves have incorporated
    the truth more readily, a newbie as myself is still trying to assure some
    level of competency to adequately manage symptoms.
    It has been my limited experience to witness a few extraordinary deaths,
    but for the most part, most of my deaths have been textbook physical deaths
    without any auras. Quite a few have seen dead relatives, and I've grown comfortable
    with this, and don't over-medicate out of fear, despite family concerns. I've learned
    to spend more time (not nearly enough) holding hands and listening; but, I'm not
    getting those extraordinary events. Why not? Do you think it has anything to do
    with the intellect/spirituality of the patient/nurse? Or is it just my inpatience?
  6. by   req_read
    Allow Mystery…

    Good question… very good question. I wish I had a very good answer.

    Sometimes when something extraordinary happens it doesn’t really sink in for awhile… not until later do you begin to think, “You know what? That was rather odd now that I think about it.”

    Then too, there are times when it starts to sink in, but then your doubts and “rational self” take over and whisper in your ear, “That wasn’t really real you know… it was just a coincidence. Don’t be a fool, let it go.” At that point it will be up to you to decide whether to “let it in” or “throw it out.”

    Sometimes things happen when you least expect them. When I “saw” a pt on the ceiling at the moment of death it was just after leaning back in a chair, relaxing as much as I could, taking some deep breaths and deliberately clearing my mind of its usual and habitual chatter.

    We constantly talk to ourselves. Think about what is going on in your head… the internal dialogue is virtually non-stop. Carlos Castenada’s Jacqui Indian teacher told him that we (humans) “spin” this world with our constant inner dialogue. He explained that to alter one’s perspective of the world one must learn to stop the internal dialogue. In his book, The Crack In The Cosmic Egg, Joseph Chilton Pearce calls this internal dialogue, “Roof Brain Chatter.” It is not hard to imagine that with a few billion people all chattering away in their heads we might be able to spin a collective reality… a shared dream. Also, in order to meditate one must first shut off the roof brain chatter. It is hard to do. The roof brain keeps wanting to start talking again, so you have to keep telling it to, “Shut Up!!!!”

    When I was sitting in that room with a dying pt and his entire (large) family, it just so happened that I shut off my roof brain chatter just a moment prior to his passing. As luck would have it, when he left his body my mind was blank… my usual perspective of the world was shut down… and I “saw” him. But after my roof brain chatter turned back on I could not “see” him any more.

    But that’s okay, I know what I saw. You don’t. For you my story is just a story. For me it was real. I know there are things gong on around us that we cannot usually see… because I caught a glimpse once… and every once in awhile can sense it still.

    The moment when you suddenly & unexpectedly “see” or “hear” or “feel” or “sense” something extraordinary, it will be personal. For you it will be real. If you tell someone about it they will view it as a story (or you as a crackpot.) If you tell someone about it when you are dying they will think you’re “hallucinating,” probably secondary to “hypoxia” or being a little too “doped up.” But for you it will be real.

    Some people are just sensitive to certain things. Recently I received an email from a person who can “sense” what dying (comatose) or dead people are saying. That is a gift. I don’t have it, but some people do.

    I’ve had Native Americans tell me they can see things we (non-Indians) do not. They expect to and do, we expect not to and don’t. But it is not easy to just change one’s expectations… you have to be born into that culture or work hard at letting go of the one you were born into.

    James Redfield (author of the Celestine Prophecy et al) talks a lot about “syncronicity” (sp?) Basically it has to do with “coincidences.” We experience coincidences all the time, and it is very easy to dismiss a coincidence as just a plain old ordinary coincidence.

    According to normal, western, classical scientific thought, the universe is dead. Everything that happens here is coincidence… from the formation of planets, stars & galaxies to inorganic chemistry to organic chemistry to big-brained intellectuals and poets. It’s all just one gigantic accident in a dead universe.

    For most civilizations however (other than our current, modern, western one) the universe is alive… the whole darned thing is alive! And it is constantly speaking to us… very often through its coincidences.

    Personally, I prefer a living universe to a dead one, so I gravitate towards world-views other than the prevailing western one I was born into. It is winter here in New Mexico, so when I get up in the morning it is chilly. I start my coffee and a fire in the wood stove. When the coffee is done I turn off all the lights and watch the shadows from the fire dance all over the walls. Then I select something nice from my collection… say a good Native American flute CD for example… then get comfortable and drift… sometimes thinking, sometimes meditating.

    It works for me.

    I do hope you are having a wonderful Christmas.

    Michael
  7. by   sharona97
    Merry Christmas Michael.



    Sharona
  8. by   leslie :-D
    to be as simplistic as possible, i happen to think that if one is receptive and hypervigilantly aware of energy fields, this will be your experience.
    and nothing surprises you.
    whenever i share a spiritual connection, i don't even question it.
    if anything, i find it comforting.
    if i go 'looking', i will not find.
    if i exist in a state of 'being', stuff happens.

    one of my son's teachers, had her father in hospice.
    she shared w/me, that she saw his spirit 'whoosh' out of his body and up through the ceiling, at his time of death.
    i only responded, "how lovely for you".
    but our eyes connected, and we understood ea other.

    often, i find words wasteful.
    most of my life, i have been guided by energy/spiritual events.
    it is an integral part of who i am.
    but that is me.
    so, for me to have these experiences as a hospice nurse, is only a natural extension of who i am.

    i don't know how to expound on others experiences, or lack of them.
    i suppose, when the thought of spirits don't frighten someone, things can happen.

    allow, i hope your day was a blessed one.
    you too, michael and sharona.

    leslie
  9. by   Ginapixi
    thanks! your point of view makes perfect sense! on the other hand we do live in a society where pain killers almost belong into the 4 food groups and people who avoid pain living - at least physical pain- do not know how to deal with pain in dying and do not want to see their loved ones in pain either. now i have to actually read the whole article out of curiosity... all i wanted was an answer to : can Roxanol be given via nebulizer? ..... look where i got stuck
  10. by   req_read
    Leslie…

    Nice hat!

    I was much impressed with your last post… to the point where I was loathe to add another as it might distract from yours. However, since someone else added a post departing from the subject at hand it seems prudent to recapture the thread.

    I confess some degree of envy… of your ability to be as aware as you are of the spiritual essence of reality. For me, instances of awareness on that level pop up sporadically… although when it does, the effect is invariably profound.

    While pondering these things this morning I decided to dig out my copy of “Down The Rabbit Hole” and re-listen to an interview with Andrew Newberg, MD – Director: Center For Spirituality And The NeuroScineces (I believe at the University of Pennsylvania.) The interview is fascinating but much too lengthy to post here (even for me.) However, you might appreciate a brief synopsis.

    Doctor Newberg researches “mystical experiences” and contemplates the nature of reality. He reports that people who do have mystical experiences report them as seeming to be more real than experiences in the physical realm. He further states that he and his colleagues have concluded that the determination of how real an experience is comes down to how real it “feels” to the person having that experience. Again (interestingly enough) he reports that people who have mystical experiences consistently contend that those experiences, while not of this world so-to-speak, seem more real than this world. Dreaming, on the other hand, seems real while one is dreaming, but when one wakes up the dream seems less real than this world (the physical realm.) He concludes that the determination of relative reality then, is subjective.

    I agree with you (Leslie) when you say, “…if anything, i find it comforting.” I too find it comforting… intensely comforting.

    In general I also agree with your statement, “…if i go 'looking', i will not find.” That has been my experience as well. Consequently, I seldom go looking. I tend to equate “going looking” with something I heard many years ago (which I think came from somewhere in the Bible, I’m not sure) cautioning against “testing God.”

    The one exception I have experienced personally are instances in which I was desperate and asked (perhaps I should say “begged”) for assistance. Qualitatively this sort of experience differs from an academic exercise of “going looking” or “testing,” however, it is an example of requesting assistance not of this world.

    Example: When I was a young man and my son was about 4, he & I were home along one day. He was fooling around in the kitchen, sitting on a stool about 3 feet high. Suddenly he fell over backwards, hitting his head HARD on a linoleum floor. The sound was sickening… not to mention terrifying. I rushed over as he lay still on the floor and held his head between my hands. In a total panic and not knowing what else to do I simply asked for help from above (elsewhere, however you care to conceive of it.) Almost immediately I felt my hands burning. This horrified me even more! I thought, “It must be brain damage. His thermostat is shot and he’s overheating.” I jerked my hands away… and then he “came to.” Thankfully, he seemed to suffer no after effects.

    Some time later, while listening to a radio interview with a woman who practiced “laying on of the hands,” the interviewer inquired how she knew when it was working. She replied that she could tell it was working when she felt heat.

    Boing! The light went on.

    Since then I have known, beyond all question, that “it” is there when and if I really need it… but it is not a toy for me to test or play with, and it is most certainly not a product of my volition.

    I have had other experiences of this nature since, but they are few & far between. I seem to be stuck in consensus society’s description of reality more solidly than you (Leslie), even though a more essential or real level of reality breaks through from time to time. However, like Dr. Newberg describes, those glimpses into another reality do seem, upon reflection (even when I am not in them) more real than this (physical) world.

    Also, my observations of dying people lead me to believe that dying process induces such mystical experiences… and I assume those mystical experiences are just as real for them as mine are for me. So when I have been asked (regarding things like dying people seeing & interacting with deceased loved ones) is that real? My response is a simple, “Yes… that is real.”

    Any thoughts?

    Michael
  11. by   FranEMTnurse
    Mike,
    I have had some personal experience with Leslie's care/input, and I have not ever had the pleasure of having a hospice nurse as good as she is. She is top notch. She has the knowledge of what meds are needed, and what else is needed like the sunglasses for her 6 yo patient. My hat will always be off to her for what she did for me. She's a definite activist for her patients.
  12. by   req_read
    Franemtnurse...

    I don't doubt that one bit.

    Michael
  13. by   leslie :-D
    Quote from req_read

    Also, my observations of dying people lead me to believe that dying process induces such mystical experiences… and I assume those mystical experiences are just as real for them as mine are for me. So when I have been asked (regarding things like dying people seeing & interacting with deceased loved ones) is that real? My response is a simple, “Yes… that is real.”

    Any thoughts?

    Michael
    newberg's conclusion of our realities being purely subjective, is right-on target.
    there is little i can truly relate to on this earth.
    but his summary, truly resonates.
    for yrs, i wondered why my relationships w/animals and young children, were much more satisfying to me, than those i had (or hadn't) w/my peers.
    i have finally concluded, that vulnerability is a highly attractive quality.
    for it represents an innocence that albeit, assailable, still remains raw, primal and susceptible.
    it is a quality i instinctively want to embrace and protect.
    conversely, being forewarned is being forearmed, inhibiting qualitative interaction.
    and so, being 'spiritual' is certainly not an enviable state to live in.
    of course, being the loner that i am, is much more conducive to a soulful existence.
    (something happened, and my post got posted, so i am now editing)
    but living on a planet where one's existence is dependent on fellowship, i find myself terribly out of place.
    i will risk publicly stating, that i have never 'belonged' here on earth.
    have always felt a misfit.
    it has nothing to do w/not being popular, confident or shy.
    i just cannot relate to people as a whole.
    and so, working w/the dying, has enabled me to expound on highly enriching, spiritual interaction.
    hospice nurses, are probably the most valued by their pts, compared w/other specialties.
    but when i tell you that i click with these people, that i can feel, am sensitized to all they endure, it is where i belong.
    for it is not based on verbal communication, but the senses (for both parties) are at the height of awareness.

    if you have noticed, michael, that i generally do not respond in detail, to your posts.
    God, while blessing me with much, did not provide me w/the gift of thinking, analyzing.
    for me, everything is about being.
    i do not even dare explore the unknown of mystical existences, fearing i will no longer be 'vulnerable'.
    i would just prefer to be.

    and if anyone understands anything i'm saying, maybe i'm not so alone.
    ha!

    good day.

    leslie
    Last edit by leslie :-D on Jan 6, '08

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