Managing symptoms for a �good death� - page 13

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   leslie :-D
    it was a good article, kat.

    (i'd like to whack that lady who's sitting, in the picture)

  2. by   req_read
    Thanks Leslie…

    The article is kind of a – “Brief History Of Attitudes And Perspectives Of Death” really.

    Native Americans have a very wide range of perspectives towards death of course, but one practice among some plains tribes was to “stake” themselves to the prairie.

    Growing old can be a real drag. Bodies wear out, don’t work well, are painful etc., etc. Have you ever wondered for example what an American Indian male would do about prostatic hypertrophy that turned into bladder outlet obstruction? Anyway some warriors felt it was preferable to die in battle than to grow old, so they would go out where they knew some of their enemies would be, then drive a stake into the prairie and tie their ankle to it… thus, staking themselves to the prairie. It was like saying to your enemy , “Here I am! Come and get me if you dare, but I ain’t leavin’ this spot!” And of course if the warrior was suffering from bladder outlet obstruction he would probably add, “And for God’s sake, hurry it up!!!!!!”

    One of the things that struck me about this article, Leslie, is that virtually all societies throughout history have assumed life goes on after death. The specifics of their perspectives varies widely, but they all assume life goes on… except us. Has there ever been a society that thought death ended life… other than us I mean?

  3. by   leslie :-D
    Quote from req_read
    Thanks Leslie...

    One of the things that struck me about this article, Leslie, is that virtually all societies throughout history have assumed life goes on after death. The specifics of their perspectives varies widely, but they all assume life goes on... except us. Has there ever been a society that thought death ended life... other than us I mean?

    i noticed the spiritual element, too.

    the u.s. is a bit more reluctant in embracing spirituality.
    for centuries, there has been a lot of religious divide and dictate.
    any spiritual existence has been typically tied up in the existence of God/higher if it is one entity.
    so many tend to confine their thinking within that tunnel, concrete perception.

    but when i think that God lives in me, you, and you and you and you and everyone, then the mind can travel and appreciate the oneness of who/what God really is.

    anyway, it was a good article.
    not a great one.
    but yeah, more of a historical and cultural perspective.

  4. by   Miss Chybil RN
    I am surprised to find this thread at a moment when I have been contemplating, for myself, what constitutes a good death. I recently read the Dalai Lama's book "How to Practice." In it, he discusses the death meditations which Tibetan Buddhists use to practice dying. The idea is that by practicing dying one should not fear it when the actual event transpires. A "good death" is without fear and dying without fear will not only constitute a good death, but bring about a good rebirth.

    I'm not sure about rebirth, I'm still working on that, but my idea of a "good death" had always been what the author in the OP's article says - paraphrasing - "If it doesn't hurt, it's good." So, to me, to die in my sleep would have been "good." However, on further introspection, were I to lay down and die, and not know that I died, would be pretty disappointing. So, I wonder, how disappointing and disorienting would it be to die all drugged up?

    Recently, I spent two days of clinical at the VA hospital hospice for my CNA class. A man of age was leaving this world. I gave him a shave and tried to "find" him with my mind, or my heart, but he was gone already - even though, he was still breathing. He had the death rattle and the nurse would periodically give him something for pain, which he couldn't ask for, and I wondered, if there is a next life, if he was stumbling into it unconscious.

    I talked to my husband about my new questions about dying. He thinks I'm a bit odd, but I asked him, "Shouldn't I be awake - conscious and drug-free - when passing from this life and perhaps into another? Aren't babies conscious when they arrive?" He didn't know. Now, I'm asking you - how much does it hurt to die?

    I had all my babies without any interventions for pain, could I die as easily? What does it really feel like to die? Doesn't the body have it's own mechanisms to deal with the pain of death? Obviously, the mind can be prepared to deal with it, as best it can. Practicing dying and alleviating the fear should lessen the pain, shouldn't it? I doubt I can be like the Dalai Lama and practice six times a day. But then, I don't have to worry about coming back as the Dalai Lama! Practicing a little should be enough for me.

    So, if I'm lucky enough to be prepared when I die, I hope I can participate in the experience without being rendered unconscious by drugs. I just don't know how to practice to withstand pain I have no experience of? Realizing that none of you are dead, (I assume), please, tell me what you know from your observations, of the pain people feel when they die. I'm just wondering, because when I die, I don't want to miss it.
  5. by   tencat
    Sometimes the death is very painful. I don't think I'd want to be 'conscious' of my horrific pain and impending death. I have seen some really awful pain with some of my hospice patients. Ideally, one would hope to have chosen hospice early enough to be able to communicate what kind of death he/she wants. If a person wishes to avoid drugs, I will honor that as much as possible. However, when someone loses consciousness, is unable to communicate and seems very distressed, you bet I'm going to err on the side of caution and try to ease suffering with drugs. Being a 'conscious' participant is fine, but I personally don't see the need to allow suffering when someone is facing death.
  6. by   sharona97
    What I have learned profoundly is that each death is so individual, that it should be handled in that way.
    You may not want to die unconsciously, but what if that is the place you are in while actively dying?
    You may not want drugs to ease a possible painful death, but as you asked, what does it feel like to die? How much does it hurt?
    The "pain" may very well be emotional, shameful, excruiating to one as certain deeds or closure to delicate areas have not been reached and closed yet, hence causing mental anguish.
    I aml learning the lessons I am learning here on this thread to expand my thought process as it applies to dying.
    I am not a hospice nurse (yet!), but the knowledge Learned here for me has been a very powerful tool for my own beliefs and I am now understanding better how to help my loved ones in my family as their lives come to closure through death.

    I feel very fortunate that I was able to be at both of my grendmother's sides and speaking to them while activley dying. Too personal at htis time to share what transpired at one of these encounters, but it blew me wide open.

    Thanks for the article Leslie.
  7. by   req_read

    Thank you for the beautiful post! It is an example of the truism that wisdom lies not so much in having the right answers, but rather in having good questions.

    No... probably none of us are dead. Then again we have all experienced transitions and death is just another transition. So in that sense, yes... we have all "died" many times and will certainly do so again.

    As far as the physical pain of dying is concerned... when I worked in ICU it was apparent that as people became more ill physically they eventually reached a point where the separation of their consciousness (or "spirit" if you will) reached a point where they began feeling less or even no physical pain. In fact, I learned that when watching a pt closely, trying to detect if they were getting better or worse, one of the primary clues that they were getting worse was when they suddenly said they were feeling better. In other words, when the spirit begins to actively separate from the body and the pt feels better, if you are going to "save" them, time is rapidly running out.

    Another gentleman I know of, who had been in a very serious auto accident and was severely injured, reported that one of the ways he managed to stay "alive" was to focus on the physical pain... because he sensed that was the key to staying "physical."

    Which brings up an interesting point to ponder. If a pt is dying but wants to stay in-body, if we remove their ability to feel physical pain might we not be removing the means for them to find their way back? Interesting thought.

    I have heard it said that non-physical entities do not experience pain the way we do. Since they are not physical, they do not experience physical pain. Being physical has its upside and its downside. It is a great learning tool or technique, but it can hurt... as we are all very much aware.

  8. by   tencat
    Sharona, I think you've got it right. Each death is individual and unique. It sounds like you will be good for hospice, if you so choose to go that route. I'm not sure what I was thinking last night when I posted as I was tired and grumpy. I think that there are many people who want the kind of death that your grandmothers had. It's a fine line between keeping physical and emotional pain under control (depending on what the patient is dying from) and keeping the patient lucid enough to participate fully in his/her dying experience. I've just seen too many patients whose family members have undermedicated for severe pain because they wanted grandpa to be 'with' it and interacting with them up to the last. I understand why they want that, but I don't understand why they want to allow the suffering. But I have seen deaths like your grandmothers' deaths, and they are very peaceful and special. It is really nice when pain and emotional suffering are not an issue and a person can go gently.
  9. by   req_read

    Yes, when people can die consciously and peacefully it is truly wonderful. Which underlines the need for studying dying process systematically, thoroughly and scientifically. Unfortunately, that is not being done. Instead, the large hospice organizations tend to focus on things like how to increase their caps and make more money. Which leaves hospice nurses in the lurch… struggling with the perplexing task of trying to balance medications with the desire to remain awake enough to experience a profound transition and thus, carry that awareness into what lies beyond.

    Yes… dealing with these issues (as hospice nurses do every day) without benefit of research or the support of hospice’s supposed guiding political organizations is frustrating and confusing. Yet there are hospice nurses out there who are finding their way on their own, bringing compassion and enlightenment to their charges.

  10. by   leslie :-D
    pain is not the enemy.
    neither is suffering.
    but any one factor that interferes w/a positive outcome, needs to be addressed.
    i've seen many, many pts cry and hurt and struggle.
    the only time i see a need for immediate intervention (such as medicating), is when one process obscures the progession of another.
    i still don't appreciate the benefit of physical pain.
    get rid of it.
    most times, a minimal level of physical pain, is all it takes to feel alive.
    pts are happy with 'just a little'.
    how can one be expected to take a journey, if they can't walk?
    moreover, pain is not the only form of awareness.
    we need to remind our pts of that.

  11. by   req_read
    Hi Leslie, and thanks…

    At the bottom of my post-before-last I stated, “I have heard it said that non-physical entities do not experience pain the way we do.” I expected someone to jump me on that… perhaps even accuse me of the mortal sin of being “new age.”

    Actually that concept is both old and new. Some Native Americans were aware of such things thousands and thousands of years ago. We modern Americans are overly impressed with our own knowledge level, but like a Native American, Ishi (Last Of His Breed) remarked, “The white man is very, very clever… but not too smart.”

    In the book, Talking To The Ground, the author describes a conversation with a Navajo man. The Navajo has been drinking beer so the first part of the conversation is kind of funny, but at one point the Navajo gets very serious and offers some true knowledge to the author. They are standing on a mesa overlooking Monument Valley. The Navajo sweeps his arm to indicate the entire valley and tells the author (paraphrasing), “We (Navajos) dreamed this.” The author is silent. The Navajo asks, “Do you understand?” The author hesitates, then says, “Ah-h-h-h-h… no… not really.” The Navajo repeats his statement, but rearranges the wording somewhat, “The Navajos dreamed this valley into existence. Do you understand me?” But the author just could not wrap his brain around what he was being told.

    Now… ask a quantum physicist how this physical universe came into existence. He will tell you essentially the same thing as that half drunk Navajo.

    We are so accustomed to thinking that we are bodies and that this universe is “real” that we overlook some very basic facts. We are almost incapable of comprehending what it would be like to not be physical, yet we spend roughly one-third of our existence in a non-physical state (assuming 8 hours sleep time.) It is good to pay attention to one’s dreams… if for no other reason than simply to acquaint oneself with what it is like to not be physical. Do you feel physical pain when you are dreaming? Think about it.

    And think about this… a (paraphrasing again) quote by Fred Allan Wolf, Ph.D. (physicist):
    “Out of body is our natural state. Being in-body is what’s hard… is the artifact.”

    Again I quote Albert Einstein (paraphrasing): “The world is an illusion, albeit a very persistent one.”

    He wasn’t kidding folks… he meant it. And if you think you can out-think Einstein, lotsa luck!

    This world is an illusion, and an incredibly valuable one at that. Keep in mind that for an illusion to work it has to be believable. For example, if you turn your clock 10 minutes ahead so you won’t be late, you will always be thinking, “Well, I have another 10 minutes.” But if someone sneaks into your house and turns your clock 10 minutes ahead without letting you know, you will always be on time. This illusion (physical universe) is very believable, so it works very well. Then again, there is a season for all things.

    As we grow older and our bodies begin to fall apart it slowly begins to dawn on us, “Hey… maybe I’m not a body after all.” We fight it of course. We dye our hair, inject our lips etc, etc… trying to pretend it ain’t so. But it is so. Eventually we come face-to-face with the inevitable… we must actually make up our own mind as to who we really are. And that is something we must do on our own, for as Leslie so eloquently put it (paraphrasing again… I’ll try not to mess it up too bad Leslie) “Spirituality is something we feel, whereas religion is something we are taught.” What we are taught does not make the slightest bit of difference when we are dying… the only thing that matters then is what we feel.

    And it is very difficult to become aware of what we feel if it is buried beneath physical pain. So yes… control the pain. That is the essential first step. But understand this… the point, the whole purpose, is to feel.

    There is a season for all things. There is a time to believe this illusion is “real.” But if we cling to that illusion beyond its time, it slips out of the realm of illusion and into the realm of delusion.

    Part of the price of admission to this physical realm is physical pain. If you volunteered for this duty you volunteered for some pain. Physical pain can be a effective teacher… but it can also be a cruel tyrant. The goal of controlling physical pain during dying process is to access the more subtle nuance of feeling underneath.

  12. by   Miss Chybil RN
    Thank you all for your heartfelt answers to my questions. I believe Sharona is right. Each death is individual and a highly personal experience. It's the last thing you get to do in this realm. Hopefully, I've got, at least, another 40 years on me before I have to do it! When my time comes, maybe things will be better for the dying, or they could be worse. Who knows? We shall see when it happens.

    Req_read, you bring up some interesting philosophies, which from my perspective tend lead to the same question. What is real? It reminds me of an old saying I read somewhere a long time ago, "The mind is of it's own place and of itself can make a heaven of hell and a hell of heaven." We all dream up everything. The existence of all things is based simply in our own perception of all things. However, this does not mean nothing exists and the physical world is an illusion.

    The physical world is very real, it is our perception of it that is the illusion. It is very hard for us to see the truth of all things, because we often miss that reality is relative. Nothing exists in and of itself, but everything exists relative to something else. A small problem may appear to be a crisis to one person while it is nothing more than a small problem to someone else. Some of us may look at a cup and think it is empty, when others realize it is impossible for the cup to be empty. It is filled with air molecules and dust particles and probably a bunch of other things we don't even know about. It might be filled with vibrating strings which slip from our universe into another the same way the strings that make up the atoms that comprise everything, inlcuding the cup and ourselves, slip back and forth together. Or, so some have dreamed...

    I could delve into the quantum realm, or the mystical realm, for hours and days. I could make these realms real by simply dreaming them. "The mind is of it's own place..." It's fun. I love playing with this stuff. The mind is the ultimate playground. It can bring joy and delusion. It can ease pain - or, cause it. It can take us "where no man has ever gone before." It can even free us when we are imprisoned. What a wonderful gift.

    Anyway, in the end, the only reality that is truly a reality, for us, is this moment. We can ponder the future and fret over the past every "this moment" we spend on this planet in our physical forms. We could dream up mesas and calculate big bangs but perhaps, for most of us, it is on the death bed when the true reality of all things comes to light. This may be when we realize how much reality we have let pass us by.

    I think I'll go smell a flower... and stop worrying about dying. :spin:
    Last edit by Miss Chybil RN on Dec 17, '07
  13. by   sharona97
    Thank you Michael for your explanations. I admit I had to laugh about the smart white men and the half-drunken Navejo. Not for any other reason then how you helped put the picture together.