Managing symptoms for a "good death" - page 9

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   river1951
    Yes, Leslie, it was for that reason. He had been a bomber pilot in WWII.
    No easy fixes- my ownb father in lawfelt guilty he had volunteered to bomb Dresden- of course that was after he had worked flying folks out of the concentration camps, we all understood, but he worried over it.
    Talking and spending the time always seems to be the answer. How we're going to get around this damn managed care, I don't know!
  2. by   BeExcellent
    That's what makes all this so GOOD. Some art, some science and mostly intuition. In the end, the only ones to ask are those left behind. Sometimes, WE are the only ones left behind. We juggle managed care, office morons (oops, did I just let a bias out?), scared folks, juicy pts, And we struggle with our own sense of life and death. To quote a commericial. It is priceless. We could not buy the intimacy, maturity and humility that comes with open hearted hopsice work.
    To answer your question Michael, my big bellied pt died just fine. Not alert, liver failure dulls the mind, but just fine. He went to bed and went deeper and deeper into sleep. The day or so he was on auto pilot allowed his family to talk about the "little boy" he had been. Who is to say that he wasn't conscious behind those eyelids? Let me throw this out. Is there a difference in death when death comes swift and unexpected, car crash, fire, massive MI or stroke? Is that a conscious death? I read an interesting thing that said when black boxes as analyzed the most frequent last words recorded are expletives. Like birth, I don't think the traveler needs to be in control or retain the consciouness. For the most part, I like life just fine but I don't think I would judge it by what I experienced at birth.
  3. by   leslie :-D
    Quote from BeExcellent
    Like birth, I don't think the traveler needs to be in control or retain the consciouness.
    agreed.
    conversely, a 'good', swift death will bypass all the evil yet necessary work to be done.
    truly, who wouldn't just want to get it over with?
    yet, through all the yrs of work w/my pts, i've consciously opted to start my life review now.
    and hopefully by my life's end, i will have taken one of the finer journeys.
    i prefer to be conscious throughout my life and not just at the end.
    makes perfect sense to me...

    leslie
  4. by   river1951
    Quote from earle58
    agreed.
    conversely, a 'good', swift death will bypass all the evil yet necessary work to be done.
    truly, who wouldn't just want to get it over with?
    yet, through all the yrs of work w/my pts, i've consciously opted to start my life review now.
    and hopefully by my life's end, i will have taken one of the finer journeys.
    i prefer to be conscious throughout my life and not just at the end.
    makes perfect sense to me...

    leslie
    Ok, guys, how I see it- this is one of the gifts from doing this work is to realize both the importance and uselessness of our lives. The importance refers to any moments we have the ability to touch another in a positive way; the uselessness of spending most of our life in a quest to pile up possessions.
    The California hospice association is putting on a teleconference next week- "Vital spiritual components to consider at end of life"- actually looks pretty good-I'll let you know what I think.
  5. by   leslie :-D
    i despise the materialism that penetrates every vestibule of middle and upper class america. i so rebel against it.
    what people amass throughout their lives, virtually amts to a pile of stuff, albeit costly to many.
    why can't we claim the material that resides within our souls?
    this 'stuff' we possess from within goes beyond costly; it's priceless.
    and yet, we treat it with utter disregard-it/we have no value.
    only cars, ipods, jewels and bling-things are attributable to honor.
    ah, thank you america, for blessing me with plastic embraces.
    give me that 5-second ambience of warm, fuzzy serenity and i will be the richest person i know.
    and that smile that can't be erased...some may say it's from the school of hard knocks.
    i happen to think those knocks are golden.
    and my feet are restless as they have a long journey ahead.
    i hope my children aren't disappointed when i don't have the material goods to leave them when i die.
    but if they ever experience an iota of what i've learned, they too will be rich.
    all they have to do is peek inside of their souls.
    it's there for all things wondrous and exhilarating.
    you won't find it in saks or on rodeo drive.
    it's so close that it's palpable.
    breathe it, embrace it, live it, my children.
    "to thine own self be true".
    life will bring you far and you won't be carrying the extra baggage of all that 'stuff'.

    leslie
  6. by   river1951
    It's not America, it's human beibgs doing what they do best, mistaking temporary comfort for hearts ease.
    Other wise, well said!
  7. by   leslie :-D
    but it is the american mentality that drives us to 'think' in terms of being successful;
    and what is success?
    that we'll never amount to anything unless we have 2-3 cars, live in a 4br 3ba house, our incomes are a minimum of $100k and that we attain every material possession available.
    it doesn't matter that we are stricken with stress-related ulcers, htn, obesity or other afflictions that represent our blind determination in being successful.
    it doesn't matter that the divorce rate is 50%+, drugs and etoh are the rule rather than the exception, that seemingly functional families are probably some of the most dysfunctional....all of this because of our need to succeed.
    what's wrong with this picture?
    people compulsively buy themselves a little something, in hopes of masking the true pain that festers beneath; only to find that one is left feeling barren and empty anyway.
    people will experience that rush, the adrenaline high only to see it plummet as quickly as it rose.
    we are not a peaceful america.
    and we have our societal values combined with the media, to thank for that.
    you're no one if you've got nothing.
    you're someone if you've got something.
    that's the stark reality of who and what america is.
    i'm just as guilty in buying a little gift for someone who's feeling poorly.
    but you know what feedback i get?
    it wasn't the gift but the gift of my company that soothed their soul.
    so to me, it seems that people truly crave the company of fellowship, recognition, validation, appreciation.
    people think they want the latest gadget, the latest craze, until they fall into the trespasses of a neighbor's embrace.
    if such encounters happened more frequently, perhaps we could unbrainwash the damage that has been so abundantly effected.

    betchya never knew i was such a cynic, no????

    leslie
  8. by   BeExcellent
    Cynic was a Greek philosopher that believed in virtue through self-control, so I am not sure if you are a cynic.
    The problem with all the "stuff" is that it gets distracting. There once was a young woman sitting in the sun fishing in her boat with her children. Everyone was having a great time (except the caught fish, of course). Along came a another woman to the dock. She was dressed great, looked good and was skinny ,too. "Hey, says the woman on the dock. Looks like you really know how to fish. Let me buy all your fish, then you can afford another boat. You can then hire some others to fish for you. Pretty soon you can be another Pike's Market, lots of boats, big market, you can be rich!" "Why would I want to do that?" asked the fishin' Mom. "Oh!" was the quick reply, "so you can be rich enough to fish all day with your kids." TeeHee
  9. by   req_read
    I’ve been so busy the last few days I had no idea all this was going on (all these posts.) How wonderful!

    Leslie… you are right of course (about the abusive father’s inner struggles with his own demons.) And I agree 110% with your view on trying to get stuff resolved ahead of time… so that my own dying process can go as smoothly as possible. Although I never seem to do quite as well as I would like.

    It is interesting to ponder just how aware people are of their blunders in life. Are murderers aware of what they did? Or do they block it out somehow? And if they do block it out is that the kind of thing (blocked out blunders) that feeds “terminal anxiety?”

    Considering anxiety as a vital sign is an excellent idea. More important, at least in my mind, than the usual VS.

    We humans are inclined to think of the physical world as “real” and “concrete,” whereas we think of things like imagination, intent and even love as sort of gauzy & ethereal. In truth it is just the other way around. This physical world and everything in it is transient. Just watch some of the science channels and observe the long list of events that can and will destroy this planet sooner or later… it is only a question of when. Imagination, intent & love are what persist and endure. For example; we use imagination & intent to produce a car. The car never lasts… rusts away to nothing… but the imagination & intent are still there. What we think of as ethereal is what is “real” and actually generates the transient phenomena with think of as being concrete.

    We tend to view our infinite needs (learning on a spiritual level) as finite. We go to church, learn the rituals & songs, get the traditions and doctrine down pat and figure that’s pretty much it. Then we are squared away spiritually… or so we think.

    We tend to view our finite needs (food, clothing, shelter) as infinite. No amount is ever enough. If we have a house, we need two. We always “need” more outfits & shoes. And food? Well… I’m getting hungry just thinking about it.

    I’m rambling again. Sorry guys.

    One more comment (I can’t help myself.)

    Good story Excellent. Yes… the point of fishing is in doing it. A “living” person (as in, not yet dying) would be likely to say, “I caught a BIG fish.” Whereas a dying person (as in, living with focus) would be more likely to say, “I went fishing.”

    Michael
  10. by   req_read
    Oh… I almost forgot.

    Self-awareness is, by definition, awareness of the whole self, not just the good parts or the parts we happen to like. It means being aware of our dark side… our not-so-wonderful self.

    So as one becomes more self-aware, one also becomes a bit cynical about humans in general. Once I come to understand what makes me tick I can see it in others as well. That’s the cynical part.

    But there is a good side to it as well. It fosters tolerance. Once I begin to understand what a jerk I can be, I am more likely to forgive you for being that way too.

    Michael
  11. by   leslie :-D
    Quote from req_read
    Oh... I almost forgot.

    Self-awareness is, by definition, awareness of the whole self, not just the good parts or the parts we happen to like. It means being aware of our dark side... our not-so-wonderful self.

    So as one becomes more self-aware, one also becomes a bit cynical about humans in general. Once I come to understand what makes me tick I can see it in others as well. That's the cynical part.

    But there is a good side to it as well. It fosters tolerance. Once I begin to understand what a jerk I can be, I am more likely to forgive you for being that way too.

    Michael
    first and foremost, beexcellent said i wasn't a cynic...waaaa.
    i wanna be a cynic too.

    on a less serious note ( ), self awareness is only productive when we can acknowledge the less desirable parts of ourself.
    through this inner journey of initial denial, self-doubt, disbelief, anger, contempt... a beautiful butterfly emerges and lets the truth soar.
    (i don't know if i said it right but i'll be damned if i try to explain it again).
    ultimately, it's our shortcomings that enable us to grow.
    so yes michael, the less we like about ourselves, the more we're apt to like in other people. for through this process of the qualities we shun, we eventually come to accept and yes, tolerate, and yes, even come to appreciate.

    btw michael, i've missed you. (kiss kiss)

    leslie
  12. by   req_read
    Well you guys have brought up so many interesting topics now I can’t concentrate on my chores.

    I have heard that sometimes people just decide to leave (their body.) I can certainly understand that. The older my body gets the more fed up I become with it… danged piece of junk anyway! In hospice I saw it all the time… patients deciding when to move on. My own mother died unexpectedly in surgery and I have this nagging suspicion that she got out of her body and decided not to climb back in. And remember the lady who I have told y’all about who died consciously with her son& best friend right there… what about her? What if her son & best friend had not been there? Then some bright nurse probably would have come along after the fact, sized up how she looked and declared, “Yup… died in her sleep.” So I think there are lots of ways to die consciously… and I also think it happens a whole lot more often than we realize. Humans have an amazing capacity to heal… and by “heal” I don’t necessarily mean staying in a body.

    Bodies don’t do well without a person in them. If the person decides to leave, the body is hung out to dry. Then a pathologist does an autopsy and says, “Died of a heart attack… yup, yup… sure did.” But I’ll bet that sometimes what happens is the body died from lack of a person… and then it filled in the blanks by having a “heart attack.”

    I missed you too Leslie. I thought maybe you were on vacation or something.

    Michael
  13. by   leslie :-D
    interesting story.
    when my grandmother died, my grandfather was literally devastated and did not want to live w/o her.
    he asked me to move from boston to queens and live with him.
    as i was readying myself for the move, he ended up being hospitalized.
    it appeared it had been a tia- he came to and about; alert & oriented x 3.
    he shared with me (and me only) that grandma had come to see him.
    she told him it was time to come home, and she would wait.
    yes, he could see her patiently sitting in the room as he and i talked.
    all i felt was an incredible draft.
    but while in the hospital, that noc, he died.
    the doctors were confounded and did not know what to think of this medical mystery.
    although he was 78, he had the heart of a 50 yo.
    my father allowed an autopsy.
    there was nothing wrong with the man.
    the doctor hesitated in writing "natural causes" although he did indeed write cardiopulmonary arrest.
    but in a conversation between him and me, he shared that my grandfather died of a broken heart.
    i just told him it was his time to go: that he had loved ones waiting.

    around a month later, i saw him in a dream.
    i had been grieving deeply and in my dream i asked him if he finally got to see grandma.
    he put his hand on my face.
    i could not feel the flesh, but only the warmth of his hand.
    and he said something to the effect of "it's a long way from new york but yes i'm with grandma"....then everything faded out.
    i had awokened with tears flowing down my face.
    i know to this day, i had actually spoken with him.

    so yes, people can and do will themselves to die.
    i speak of my grandfather but i've seen it dozens of times in hospice.
    they're ready to leave and so, they do.
    it's such an amazing, amazing process.
    something i'll never get used to.

    leslie

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