Managing symptoms for a �good death�

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Allow Mystery

77 Posts

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

ego.

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

vulnerbility.

Take Care, thanks for your thoughts!

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

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?

Michael

sharona97, BSN, RN

1,300 Posts

Specializes in IM/Critical Care/Cardiology.

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.

Thanks,

Sharona

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

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.

Michael

sharona97, BSN, RN

1,300 Posts

Specializes in IM/Critical Care/Cardiology.
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.

Michael

Hi Michael,

I guess I wasn't that far off as I understand completely the paradox. I agree that the two very powerful urges are in us all, (and that it takes a chapter or three for me), your explanation and examples like I said I get it. Really thank you.

But where does this mental illness part come in regarding ego. The reason I ask is that I maybe naively believe that there are folks out there that do get it, from day to day, and deal effectively with life's surprises! Which helps obviously at the time of their death. Not so much baggage so to speak.

For those other folks who are "too busy" with life to ponder the what if's (and when's) I can understand how frightened they may be and the light bulb goes off. Ah Ha, ("So this is how it's always been, really") so what do I need to do?

Which leads to me to almighty question, which book Michael? lol! Seriously, I am committed to this and really appreciate all info from the hospice nurses. You know who you are!!!!

I appreciate your tolerance with a (not yet hospice) nurse!!

Take Care,

Sharona

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

Sharona…

I sent you an email.

In General…

It does seem to me there is value in individuation… the process of developing personality & character… and that it would be a shame to discard that at the so-called end-of-life.

I once heard an interesting explanation of ego versus negative ego. The gist of it was…

Ego is a good and necessary thing. It is a helper, sort of a clerk that one employs to tend to certain, rather menial tasks. But we get lazy. Little by little we allow ego to take over more and more of our routine chores until eventually it begins to usurp control. Finally it reaches the point where it has taken over complete control of our lives. At that point it is no longer a good thing. In fact, if we try to grab control back, it tries to kill us.

So ego winds up with a bad reputation and takes the heat for lots of objectionable behavior patterns. Yet in and of itself, it is good and necessary… if we just manage it properly.

Michael

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

Regarding suffering…

In a wonderful interview with the late Joseph Campbell (I have it on tape) he describes an Eastern god (from India as I recall) that is depicted as simply a head. I can neither spell nor pronounce this god’s name, but that is beside the point. This particular deity is carved into the entrance of certain temples and represents “life” in the physical realm.

Life in the physical realm consumes itself. That’s just how it is. Living things here must consume other living things in order to survive. Even those things which we generally construe to be non-living (inorganic things like rocks & mountains, stars & planets etc.) are continually being created, destroyed and recycled as it were.) So life in the physical realm lives on (eats) itself. Hence the head… it ate itself, starting at its own tail and working its way up. Finally, only the head was left. This god is carved into the entrance of the temple, signifying that if you cannot accept it, you may not enter the temple (physical realm.)

In Judeo-Christian lore this concept is depicted in the Garden of Eden story. It is allegorical of course, and has to do with eating in general, not with apples in particular. To “live” here (Earth) you must eat (consume other living things) and eventually be consumed (die) yourself. If you want to play on this playground you must don the appropriate gear (a body) and play by the rules (consume and be consumed.)

If you accept the posit of the quantum physicists, not to mention all the great spiritual teachers of history; i.e. that all the diversity we see here in our “infinite” universe is manifested by a single (unified) consciousness (God, Allah, Jehovah, Great Spirit, whatever) then the allegory of the Indian head god (eating itself) is perfectly sensible. Which, no doubt, makes a certain level of suffering inevitable here on this playground.

So the next time a pt dies and a family member turns to you tearfully and asks the inevitable, imploring question, “Why,” perhaps you will think about a head carved into the entrance of a temple somewhere.

Which begs the question…

Even if one understands life & death, does it matter? We sometimes think that understanding will take away the angst & pain etc. It doesn’t. So why bother?

We often assume the goal of understanding is to remove the emotional component or consequences of our experience. Is it? Or are our emotions important in and of themselves. We are inclined to think that emotions are mere side-effects or by-products of our experiences. Perhaps they are the goal of our experiences.

Why must we feel sad? Is there something in sadness that is valuable?

Michael

leslie :-D

11,191 Posts

Even if one understands life & death, does it matter? We sometimes think that understanding will take away the angst & pain etc. It doesn't. So why bother?

We often assume the goal of understanding is to remove the emotional component or consequences of our experience. Is it? Or are our emotions important in and of themselves. We are inclined to think that emotions are mere side-effects or by-products of our experiences. Perhaps they are the goal of our experiences.

Why must we feel sad? Is there something in sadness that is valuable?

Michael

i think it was carl jung who stated, "the foundation of all mental illness is the avoidance of true suffering."

yet, esp in our society, not only do we avoid death, we avoid any type of suffering.

we have a pill for every ill.

still, it is difficult in coming to terms w/such powerful and negative emotions...

precisely because they are powerful.

they are primal forces in a modern world, and remind us that maybe, we aren't so civilized afterall.

as a result, we lock up all of our creative and positive energies, in attempt to deny the primitive, primal, uncomfortable emotions.

and so, we are unable to accomplish anything productive or meaningful in our lives.

to repress the negative, we can never be whole or healthy.

i have heard some say that fear, anger, despair, are the work of satan.

yet it comforts me to observe that all who believe in a God, Buddha, Allah, we all look upwards during times of angst.

love prevails.

good over evil.

our path to the astral world, is enlightened.

my soul is comforted.

can you imagine man not having emotion?

we would either be walking, talking lunatics or welcome-to-the-world-of-robotics.

nah.

i'll gladly take the pain and suffering, that accompanies joy and exaltation.

my intellect allows and embraces its emotional counterpart.

aren't they what makes us whole?

leslie

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

In our business we have unique opportunities to study human beings. But that is merely a potential. To push that potential into real understanding we have to be honest.

Dying process forces a thorough, internal reality check like no other. It holds up a mirror and demands, “LOOK! What do you see?”

The two major angst-producing factors in dying process are; 1- the fear of ceasing to exist, and 2- the thorough self-examination that dying process demands.

Too often, caregivers attempt to gloss things over. Rather than assisting people to confront and actually feel the consequences of the not-so-pretty things they may have done, caregivers often encourage the dying to ignore, rationalize or flat out deny large chunks of their lives. This phenomenon gets carried over into funeral services where even the most unscrupulous characters are often re-invented in memoriam.

It is not that we ought to condemn. That is not the point. The point is, no one is perfect. So we should work on being comfortable with imperfection; pain, angst, fear, resentment & regrets… as opposed to sweeping all those things under a pharmacological rug. It is hard to accept one’s own screw-ups, but if someone else can, (like a hospice nurse for instance) then we can start to think, “Well, if she can accept me, maybe I can too.” But denying, ignoring, minimizing or burying one’s faults is not the same as acceptance. To accept, one must first acknowledge… so we have to be honest… to look at who we are from all angles.

Here is an example with a certain element of humor (some might say, “dark humor.”) As most of you know, I grew up on a farm. I have also hunted and fished most of my life. When I first got into the medical field I was an orderly and assisted pathologists doing autopsies. I have taken apart lots of bodies; from squirrels to trout to chickens to cows to deer to people. And I have to tell you, they all have the same basic operating system. They are all essentially an alimentary canal with various peripheral hardware and configurations. We are all just GI tracts on wheels. Actually, some critters are on wings, some are on fins, some on 4 legs and a few of us on just 2… but we are all basically mobile alimentary canals. Interestingly, the snake (of Garden of Eden fame) works so well in allegory because snakes are about the purist form of a GI tract in the animal world… little more than a tube with openings at both ends. To be physical you have to consume and be consumed. Pretty basic stuff really… being physical.

The beauty (or lack of it) we assign to the various configurations of mobile GI tracts is, of course, subjective. My wife & I reached almost instantaneous agreement on this issue… the very first thing we both thought of was horses.

Be that as it may, to really understand life & death one must, at least a little bit, pare down our usual, quixotic view of who we are. Not that a quixotic view is immaterial… it has its place. But for the literalist who thinks there actually is a Garden of Eden in the physical realm… if you really want to get literal… then do it! If you like literal, then by golly let’s get down-and-dirty literal. If humans were created in God’s image, does God have an anal sphincter?

Or maybe… just maybe… could that be allegorical… just per chance?

Michael

sharona97, BSN, RN

1,300 Posts

Specializes in IM/Critical Care/Cardiology.

Hello All,

Adversity has taught me that pain and suffering brings "things" forward. To a bettter place, to a better understanding in life for me. And that is where it stopps.

Your posts really drive home that it's ok that it doesn't drive Joe Schmoe home (yet), but that is where my confusion comes in. How come Joe doesn't care about the big bad ego, or intentionally putting pain and suffering toward someone and not think twice about?

Yet when the pain and angst hit me, Yes, it hurts, but I grow and learn from it.

So yes I believe pain and suffering have a specific purpose in our lives, it is up to the individual to use it and grow or bite their own head off........

Thanks for such great posts

Nice to hear from you Leslie, you are missed.

Michael, thank you for the Email.

Sharona

req_read

296 Posts

Specializes in Med-Surg, ER, ICU, Hospice.

During my years of working in healthcare I observed that the practice of medicine is a combination of science and art. I also observed that when docs first start out their practice is mostly science, but as they grow older, more experienced and wise, their practice becomes mostly art.

The same could be said of hospice nursing. The article that instigated this thread (remember that?) presented hospice nursing as mostly science (and that mostly pharmacology.) Now, all this time later (over 200 posts and 52-thousand views) it is apparent that hospice nursing is an art.

We have all heard things like: Beauty is in the eye of the beholder, and good art cannot be defined… but I know it when I see it.

Learning the science of hospice nursing takes some time and has is complexities, that is true. But compared to the art of hospice nursing, that is merely entry level… kindergarten stuff.

The art of hospice nursing involves a deep understanding of life and death (that the latter has just as much purpose and value as the former), of human nature, a true ability to think outside of the box (as opposed to the trite lip-service that is paid to that concept these days), a willingness to feel and understand the potential value in pain, angst, fear and sadness as well as joy and hope, the vulnerability to reach out and expose one’s self to another knowing you may get hurt for your trouble, the willingness to open up to extrasensory perception (both your own and that of others), the ability to accept and forgive the ugly side of another human being, and perhaps more than anything else, the ability to look honestly at your self.

Dying process is not studied, so those who become hospice nurses are, to a large degree, on their own. The art of hospice nursing is not taught, it is learned… mostly from dying people. About half of hospice nursing is teaching… being the teacher. The other half is learning… being the student. Those who aspire to be a hospice nurse need to understand that dying people can teach you how to live.

Michael

sharona97, BSN, RN

1,300 Posts

Specializes in IM/Critical Care/Cardiology.

I, myself truly believe the angst, adversity, the "not so nice stuff" helps keep one whole.

I can only imagine what the hospice nurses see in individual family members as "they all come together" to be next to their loved ones in their actively dying moments.

I've come to conclude that in order to keep sanity and give all I can to help positively towards the dying individual is to let the others hopefully get to and accept the emotional opening up of themselves, by themselves instead of worrying why "they" are not.

Teaching and learning........throw a little suffering in there (family stuff) and I think the nail has been hit on the head.

Sharona

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