Managing symptoms for a �good death� - page 16

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   req_read

    I not only understand, I empathize.

    I have heard it said that we are in this world but not of this world. For many that is something to think about… to ponder. For a few it is obvious, sometimes painfully so.

    Children, before they are socialized; i.e. before they have constructed the social mask they will wear throughout adulthood, are themselves… no put on, no pretense. Dying people’s masks get stripped away by dying process itself, revealing the real person who has been hiding behind the mask. So these two groups have a lot in common. They are who they are… with a minimum of affectation or deceit. That is why it can be more refreshing to hang out with dying people than with living people (or not-yet-dying people.) Kids and dying people are real. The not-yet-dying are, in Shakespearean terms, actors on a stage.

    Analytical thinking is my department (or curse.) Yours seems to be feeling and knowing directly.

    Years ago I was sitting, thinking… lost in deep thought… when I suddenly realized I was not thinking in words, but rather, in concepts. Words are an artifact. Some concrete thinkers have difficulty understanding or accepting the idea of metaphor… without ever realizing that ALL language is metaphor. In computer terms language is rather like the old Windows 95 operating system… one system (Windows) built on top of and operating through a secondary system (DOS.) Very inefficient!

    We like to think that we (humans) are especially intelligent because we have learned to communicate via language. Actually, when not in the physical realm, we communicate telepathically… directly… conceptually… no language necessary. We like to think we invented language so we could communicate better. It would probably be more accurate to say that we invented language so we can lie. When we ask someone how they are feeling and they say, “Fine,” we take them at their “word.” But if we look them in the eye we may feel they are hurting.

    Lying isn’t all bad though… we aren’t total jerks. It may, in one of its forms, actually be involved in creative process. But that is another story… the idea or concept for which may take some time to translate into language.

    For me, the most comforting thing about mystical experience is that afterwards I usually have an overwhelming sense of, “I am not alone.” It is not unusual to simply fall down weeping at the overwhelming power of that realization.

    The Greeks had words for the will to live and the will to die… Eros & Thanatos. Both are powerful motivators.

    I have come to view Eros (will to live) with ego… the illusion of being separate from (God, Goddess, All That Is.) It revels in its freedom and independence and is an incredibly powerful motivator. When we are dying it bites us in the bum. At some point during that process we are horrified at the possibility of losing our individuality and fall into an absolute panic.

    But at some point the will to die takes over; i.e. the will to reunite, to come in out of the cold, to go home. It is the intense longing to not be alone any more.

  2. by   sharona97
    Quote from earle58
    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.

    good day.

    Vulnerability is an attractive quality is so true and I totally understand your thought on that and I believe in it. I thought I was the only one! Vulnerability is not martyerdom, a bad thing, it is rather who "you" are. Thanks for sharing that. You are not alone in my book!:innerconf
  3. by   sharona97
    So perfectly said and underdstood Michael. God had blessed me with tears and I am living prove of falling over due to the powerful feelings I recognize and feel and I let the tears flow, for healing or for others in their healing. In my current situation knowing a dying person will then "come back home" as you stated just blows me away. I'm really not losing it, I'm observing and living the situation. Thank you.
  4. by   leslie :-D
    Quote from req_read
    It would probably be more accurate to say that we invented language so we can lie. When we ask someone how they are feeling and they say, “Fine,” we take them at their “word.” But if we look them in the eye we may feel they are hurting.
    truly, a thorn on my side.
    hence, the reason why i do not use that ubiquitous phrase.

    as it pertains to nursing, it bothers me when we ask if a pt is in pain and the pt says no.
    and so, we write in our notes, "pt denies pain".
    and that's the end of our assessment.
    nevermind the elevated vs, the grimacing, the guarding, the hesitation, the lack of eye contact, etc.
    "pt denies" is sufficient.
    and we go on w/our day, as they go on w/their pain.

    i'm sure you've heard me state more than once, that words are wasteful.
    this is precisely why i say this.
    for the most part, it is all a sham.
    if one wants to have meaningful conversation, sit w/a child, the dying, a crochety elderly.... there we find substance: not always tangible, but always convicted.
    otherwise, i will continue to revel in my solitude, and still, i am never alone.

    this is a conversation i could probably ramble on about.
    but alas, i must iron my clothes for work tonight.
    i appreciate your empathy, sharona and michael.
    i 'feel' that you both get it.

    with love and appreciation,

    Last edit by leslie :-D on Jan 7, '08
  5. by   Allow Mystery
    Well, finally, something I can relate to, maybe that lightbulb is
    getting brighter. Thank you Leslie for sharing your vulnerbility, we
    are all vulnerable but don't want to share or lie about.
    I've always been drawn and able to relate to the 'mentally retarded',
    or what we now refer to as "disabled" or "handicapped". Pure innocence, and simplicity, and no pretense. I often wonder who
    are really the 'retarded' ones.
    And this is probably why I've been drawn to Hospice and relating
    to the dying individual, because I find that the dying individual will
    usually become innocent, simple and unpretentious, qualities I may endure.
    God bless!

    Michael, after responding mostly to what Leslie shared, I reread your
    posting and realized I simply modified my experience with your analytical thoughts, I didn't mean to steal or plagiarize. Take care!
  6. by   leslie :-D
    Quote from Allow Mystery

    Michael, after responding mostly to what Leslie shared, I reread your
    posting and realized I simply modified my experience with your analytical thoughts, I didn't mean to steal or plagiarize. Take care!
    if anything, i think it shows we're all on the same page.

    it's unfortunate that it takes death (or handicap), to expose who we really are.

    we are all so palpably connected when innocent.
    why does man need to mask himself (from himself) and ea other?

    for as much as death is rejected in this society, it seems this is when we have achieved our absolute best....when we have self-actualized, according to maslow.
    i shake my head at the ironies.

  7. by   FranEMTnurse
    Quote from earle58
    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.
    My daughter Laurel is exactly like this, and I know why you feel this way. You feel safe with this type of beings. They are vulnerable, and are no threat to you in any way, just as Laurel feels.
    I too was a loner as a child and for most of my life. It was only when I was forced to get out in the world that I began relating. In fact, it has been only the past four years that I am so open. My therapist was successful in bringing me out of my shell.
    Last edit by FranEMTnurse on Jan 13, '08 : Reason: Not enough info
  8. by   req_read
    Leslie, Allow Mystery et al…

    It does seem that we are on the same page.

    I have long assumed that careful observation and close interaction with dying people would reveal the same or similar types of phenomena… just one example of which is- dying process strips away our social mask… and since who we are will be thrust upon us whether we like it or not when our dying time arrives, it would probably behoove is to start getting acquainted with our self now… so we won’t be entirely shocked when forced to show our hand.

    This also points to why those who think they will have no fear of dying, based solely on a strongly held belief that they will survive it, are nearly always frustrated in the proverbial “end.” Even if a person happens to know for certain they will survive death (which few do despite their claims to the contrary) they will still have to go through the process of having their social mask stripped away. We still have to look honestly at all of our own faults and actions. And unless a person happens to be perfect, this will probably not be one of the most fun activities we will ever undertake.
    Having never run into a perfect person myself (dying or otherwise) I finally gave up on trying to find one who could go through dying process with no fear, angst, regrets etc.

    I have long held that dying process teaches us how to live. And yes… it does seem highly ironic that such profound lessons would occur at the “end of life.” It all seems sort of backwards. Or at least it does if one assumes death ends life.

    But here is one of the most fascinating things about all of this. “Ego” gets such a bad rap. Eastern spiritual teaches have long taught that it is the ego which stands between us and enlightenment… is the thing which must be overcome. Modern psychologists make lots of money attempting to help people remove themselves from the dastardly clutches of their own ego. Leading thinkers point out to us that it is the low-down ego which is responsible for creating the illusion of our separation from unified consciousness (substitute: “God.”)

    So if we live our lives pretty much at the direction of our ego, only to have it stripped away, why do we have it in the first place? What was the point? Someone sure went to a lot of trouble to set up this system if it is all just some sort of mistake.

    Unless we assume God, Goddess, All-That-Is is just a fumbling Klutz, we will have to seriously ponder the possibility that ego may actually be useful… in some obscure way.

    Come to think of it, we would also have to make the same assumption about death; i.e. that as much as we despise, loathe, fear and blame it for virtually all things evil, unless we are prepared to assume God is an idiot, we might have to reconsider how we view death. In other words, we might at some point have to entertain the possibility, remote as it may seem, that God is smarter than we are.

    If anyone on this planet ought to consider the possibility that death may actually have some useful purpose, I should think it would be hospice nurses.

  9. by   FranEMTnurse
    Good bye!
  10. by   Allow Mystery
    Michael, intersting points you make.
    Ego could be the social mask that
    gets stipped away at the end;
    Ego served it's purpose on earth,
    for survival, but does not have a place
    after our time here; those that struggle
    with their death, don't want to let go of the
    To prepare for death, would require we
    let go of the ego, which would take an
    enormous leap in faith, and sacrifice.
    Some are willing, many are not.
    Letting go of ego without pending death,
    enlightment, may be dangerous in our
    world, as it leaves us vulnerable, and
    may lead to isolation and frustration;
    relative few are willing to try and many
    end up depressed/mentally ill.
    Hospice nurses may learn sooner that
    the ego does not serve in death so we
    are more aware of the need to strip the
    masks, thus our isolation and frustration and
    Take Care, thanks for your thoughts!
  11. by   req_read
    First let me state that pondering issues such as these is, I believe, important for hospice nurses. We deal with dying people. When people are dying they think about these kinds of things and turn to “experts” for assistance, encouragement and support. Yes… knowing how to adjust meds is a necessary skill, but having given some thought to broader issues is helpful as well. Also, it is obvious to a dying person (and their relatives) when the expert has put some serious thought into a question, or is simply regurgitating what they have been taught.

    I have brought up this point before, but it is worth repeating. There are things that can only be said after having earned the right to say them.

    Experienced hospice nurses can say things to a dying person that are accepted because of their depth of understanding of that issue. However, if a student hospice nurse were to repeat the same thing (verbatim) without a corresponding depth of understanding, she could quickly get into trouble with a pt/fam. No doubt many of you experienced hospice nurses have seen this happen. A rookie asks, “What should I say if… whatever?” You tell them what to say, they say it and BOOM! It blows up in their face. Why? Because they lack the experience, thought and depth of understanding that went into the answer they regurgitated.

    Which points to the value of contemplating the deeper meanings of life & death (for people who are dealing directly with life & death.)

    Allow Mystery…
    You make an interesting point. I never thought of that. I just assumed there must be some purpose to ego other than as an adaptive mechanism necessary for survival in the physical realm.

    This realm is obviously temporary. Nothing here lasts. Our presence here must be seen within the context of a transient learning experience, rather than as a permanent residence. We did not come here to stay. Even if we cannot accept that in the short term, our scientists have pointed out a multitude of ways in which our planet and solar system will eventually be destroyed… not a question of ‘if,’ but rather, ‘when.’

    So I assume we came here to learn… but learn what? Plus, we are paying a price to be here. It ain’t easy being physical. It is not our natural state and it entails suffering, so whatever we came here to learn it must be important… valuable. Buddhists accept that part of our experience in the physical realm includes, by necessity, suffering, so they devote time to pondering the purpose of suffering… and ways of minimizing its effects. Which is an interesting irony in itself; i.e. we assume there is a purpose to suffering, so we ponder its purpose… and ways of defeating it (and presumably its purpose?)

    After years of apprenticeship Carlos Castaneda was sitting with his master reviewing the lessons he had learned. Don Juan (master) mentioned that hallucinogenic drugs were harmful to one’s health. Carlos was shocked. “Then why did you give them to me?” (early in their association) he demanded. Don Juan told him (in a nutshell), “Because you are so stupid.” Don Juan explained that because Carlos’s world-view was so narrow and limited, and he clung to it so adamantly, that the only way to get him out of it was to blast him loose.

    It is quite true that suffering can be a very effective teacher. However, it is not necessary. We are capable of learning much of what we do without having to be prodded by suffering. But we are pretty darned stupid, and inclined to cling (with white-knuckled determination) to our old world-views. Take gasoline for instance. Everyone on this planet has been aware for a long time that we will eventually run out, yet we have made almost no preparation for that certainty… until it is literally upon us. We build homes in flood plains… because it hasn’t flooded there lately (although we know perfectly well it will again.) We know that many of our social, economic and ecologic problems are exacerbated or directly caused by population explosion, yet we consider it our right to explode it. And so on. As much as we like to tell ourselves we are the epitome of intelligence in the universe, we had better start praying that we aren’t.

    Pardon my taking the long way around the barn, but…

    Is ego, with its concomitant separation perspective, a goal in and of itself? Or is it merely a means to a greater goal? Did we come here (at least in part) to individuate… to develop personal character and individuality? Or is individuation merely a prerequisite for participation in this (transient) physical realm? (Sort of along the lines of wearing a snorkel & fins is necessary to go scuba diving… or putting on a space suit is necessary to go space walking.)

    Perhaps both… some combination thereof?

  12. by   sharona97
    Michael and Allow Mystery,

    Excellent thought-provoking posts, thank you.

    My question is about ego vs egotism. I understand the mask of ego, but without wearing a mask and simply going about your life with knowledge about suffering approproately to me is one thing.

    Egotism speaks to me that it is a purposeful "attitiude", if you will and may perpetuate depression/mental illness. Possibly due to unpreparedness of what is to come, or understanding the natural suffering that folks will come upon, kind of like hitting another milestone in their life and taking it for granted and then reacts when the milestone does not bring this person forward, growing, therefore they become angry, depressed, and possibly into a mental downfall.

    I certainly believe as an individual we form our character (learned and unlearned) which may aid in developing an "ego", per se, but I'm not sure that could be the cause of depression and mental illness, if we have not reached our full potential.

    Whereas egotism speaks to me as one with a purpose that is not of suffering, basically carrying on with life , maybe with blinders on.

    Am I way off here? I'd be very interested in how depression and mental illness plays a role in the living of this world associated without/with ego.

    Is it possible depression sets in due to a crisis that is unexpected rather than "denying that the person recognized the true suffering needed to encounter "getting an ego"

    I recognize many folks dealing with depression or those with a mental illness, but I have a hard time believing this was caused by one not acknowleding an ego which begets the suffering that is needed and to be understood. Otherwise are they truly walking around with depresion and or mental illness without their own knowledge?

    I do understand that the actively dying person who needs to talk of suffering and other delicate issues (especially to seasoned hospice nurses) at that point in time will either become beneficial or detrimental to the experience at that time.


  13. by   req_read
    I’ve been thinking about the possibility of ego being a survival mechanism (in the physical realm) for a couple of days… sort of in the sense that wearing scuba gear is necessary to go scuba diving. After leaving the water the gear is no longer necessary (indeed, is quite cumbersome) and is then removed.

    It has been a very interesting couple of days… wrestling with this hypothesis. It has brought together a variety of concepts… into a rational stream. Yesterday morning, after talking (rather excitedly) about all of this with my wife, her comment was, “Boy, you sure are wired today.”

    Thorough (or even an adequate) discussion of this subject would require a chapter or two in a book. I would say however, the loss of self-identity equates to- loss of self… which equates to- ceasing to exist (from self’s perspective.) So if we assume we discard ego (like scuba gear) then we are likewise discarding our self. This is the existential horror faced by dying people… the horror of ceasing to exist.

    Which is offset by the longing to- go home (etc. and so on.)

    We have two extremely powerful urges: 1- The urge to preserve self (self-identity) and 2- The urge to be re-absorbed into an expansive (single) identity.

    These two powerful urges are, I believe, paradoxical… in the sense that both are relevant and exist… despite the intellect’s insistence that only one can be relevant and exist. In other words, we are both ALL ONE and EACH UNIQUE simultaneously.

    The grass is always greener… so when we are in Self-Awareness we long to be connected, and when we are in Atonement (at-one awareness) we long to be just little ol’ “Me.” We’re never happy… at least (presumably) not until it finally sinks in (to our rather thick-headed intellect) that we are BOTH.

    Like Dorothy (Wizard Of Oz fame)… Honey, you’ve always had the ability to go home.

    What is really interesting (and would require a couple of chapters) is thinking about and observing how folks who lean towards one side or the other of this paradox behave… and particularly (since we’re in hospice) how these thinking and behavioral patterns play out in dying process.