Managing symptoms for a �good death�

[NRSKarenRN]

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

What's a good death? Most patients facing the end of life say it means freedom from pain and other distressing symptoms. 1 as nurses, we can play a major role in easing their way to a good death.

Managing symptoms in the last phase of life is especially challenging because you probably won't have the benefit of diagnostic studies to help you assess signs and symptoms. But as a nurse, you bring unique qualities to the table: assessment skills, a partnership with the patient and her family, and the determination to bring comfort.

In this article, I'll present a case study to illustrate the most common end-of-life symptoms, including pain, fatigue, dyspnea, and gastrointestinal problems. Whether your patient has all of these symptoms or only a few, you'll learn how to keep her as comfortable as possible.

[FranEMTnurse, CNA, LPN, EMT-I]

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. :up: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.

[req_read]

Franemtnurse...

I don't doubt that one bit.

Michael

[leslie :-D]

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

[req_read]

Leslie…

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.

Michael

[sharona97, BSN, RN]

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

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

[sharona97, BSN, RN]

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.

[leslie :-D]

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.

ah....

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,

leslie

[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!

[leslie :-D]

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.

leslie

[FranEMTnurse, CNA, LPN, EMT-I]

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.

leslie

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.

[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.

Michael

[FranEMTnurse, CNA, LPN, EMT-I]

Good bye!