Managing symptoms for a �good death� - page 27

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   finn11707
    Consciousness can be a difficult cross to bear. To paraphrase a quote from The Great Gatsby, "His was a great sin who invented consciousness. Let us lose it for a little while."...
    Should we not likewise consider "good death" to be one in which one's investment yields a good return... as much growth as possible for the steep price that will be paid regardless?]

    These two parts of your post reflect both ends of the spectrum of our work in Hospice, I believe. Careful listening and exploring in our work with each individual will lead us to what their wish is. Some may be able to understand that they can grow through the process and embrace the work. Others may want to 'lose consciousness' or palliate the issues that rise through sedation. Those of us who attend individuals who have lots of angst accompanying their dying process must take care to offer kind and compassionate help. It is a challenge wittnessing the angst when we know that much learning, growth and healing resolution could come with the process...if allowed. But, we are not the ones choosing for the individual what is needed for a good transition and a good death. We are employed to journey a little while with dying individuals. To offer support, compassionate guidance, palliation of symptoms, and, if asked for, our insights about dying process and all that it can be.

    How many of us have begun a new hospice assignment working with a patient/family who guides that they "do not want to talk about dying".
    Some even know, when we ask leading questions to engage in life review, that we are headed toward talk about their dying. These are the tough cases and perhaps are not as rewarding for us, when we are limited in sharing our knowledge and guidance toward healing and growth work in what the dying process can teach. Perhaps case loads should be screened by the intake nurse and separated into clear categories: Those who want to learn and grow through the dying process, and, those who want to just die with everything smoothed out - more Morphine and Ativan, maybe Phenobarb, and no delving.

    Then there is the reality of how many intense cases one Hospice nurse realisticly can manage well one time. If I have, say, 3 of my 12 actively dying, another 3 fully engaged in intense work such as forgiveness work/ healing riffs relationships, and 3 newbies requiring all the extra entry info mandated and 3 who are zoned out in denial; how much energy is available to each? Do I secretly wish for the next admission to my caseload to be either a very early hospice admission or someone who does not want to engage in end of life work?

    When a Hospice agency is not devoted to the spiritual nature of Hospice work and so does not support its Nurses, MSWs, and Chaplains in working this way, as a team; when all parts of the team are not on the same page or do not have necessary committment or skills to attend to the spiritual nature of the work, the work is limited to 'medical model'. Western Medical model denies focus on the 'whole person'...excluding important spiritual aspects of the indivdual, and thereby, the true nature of Hospice work. Medical model pares down our work as nurses to offering an arsenal of medications and instructing patients and families what to do when and what happens as the systems shut down; but delegating questions of a spiritual nature or signs of need for spiritual work to Chaplains and Socialworkers who might be available once a month. Many 'moments' are missed if work is done this way. By the time the MSW or Chaplain arrives, the opportunity is often gone. The work nurses do is spiritual by nature. It is not framed as such by western medical model, but it is. That is why a patient may open to us, asking for us to help them address a spiritual part of the dying process. At a certain point in the process of dying, every individual 'gets it' and looks toward us to affirm the spiritual tilting...the expanding consciousness, and help with the knowing that their body and we as hospice workers must pause while the spirit, the soul journeys on.
  2. by   req_read

    Very well thought out and written post I must say. I believe it reflects a fundamental difference in our current views; i.e. you are currently working in hospice and I am not. While I think and write about dying you deal with it, hands on, every day. As a consequence, my posts tend to be more “theoretical” while yours seem more “clinical.” I believe they are complimentary however.

    As regards one of your several, well-made points I reference a few lines from a song by Kieran Kane & Kevin Welch.

    “Old dirty dog walking down the street,
    no shadow did he cast.
    Clock on the wall,
    no hands at all,
    no present, no future, no past.
    You can’t save everybody,
    no word, no deed, no praise.
    You can’t save everybody,
    everybody don’t want to be saved.”

    As you suggest, getting “involved” is both time consuming and terribly draining. If all your pt/fams were actively working on their issues you could probably only handle a case load of about 3… which explains why management would rather you had no such involvements at all.

    Regarding hospice nurses & spiritual work… quite so, quite so… that is what it often is… or at least can be if the nurse is so inclined. And I would further suggest that it is often the nurse more than the SW or Chaplain for 2 reasons… one of which is largely logistical and the other is merely a potential.

    The logistical factor is that the nurse is there (more than the SW or Chaplain.) Simply being present is a huge factor, because the pt/fam is not always willing to talk… spill their guts. That is often something that just sort of happens out of the blue. It is a cubic centimeter of chance. Think about yourself. Do you just decide you want to have a heart-to-heart talk and then jump on the first person who happens through your door? No. It is one of those “when the moment is right” sort of things. And even when it does start to happen… when you feel an overpowering urge to “let it all hang out”… you might also have a feeling of foreboding… like, “Oh God! I don’t really want to do this… but here I go anyway.”

    So it is the one who is there the most… who is the most familiar… that is most likely to be the recipient of the pt/fam’s shared, innermost thoughts & feelings.

    Then there is the factor that is merely a potential… that might possibly draw the pt/fam out. This factor is far more ethereal, yet I believe it is very real just the same. It is the “birds of a feather” aspect. Like-minded people tend to recognize or sense their like-mindedness in one another. When you walk into a room full of people do you notice being drawn to those with whom you share certain thoughts & opinions? People with whom you feel more at your ease? Are you not more inclined to speak openly with those folks than with others who may have traveled in different circles and hold differing views? For example; I have spent a lot of time in the west where hot chile, cowboy hats, course clothing, course language and carrying guns is normal. Now I rub shoulders with a lot of retired executives and business people who dress very nicely, frown on cussing, would choke on a good Hatch chile and play a lot of golf, (which strikes me as one of the more bizarre forms of entertainment ever conceived.) My father-in-law loaned me a jacket for Thanksgiving dinner (I don’t own one) and as far as I am concerned, golf balls would make good targets for hip-shooting with a Colt revolver, but little else. These people leave me feeling like a stranger in a strange land.

    Dying people find themselves in a similar quandary. Dying process forces them (us) to look more honestly at our self… which leaves us feeling more like strangers in a strange land. As this process plays out we are more attracted to those in the room who we can sense have had similar experiences. We would naturally feel safer with that kind of person, and would likewise be more likely to open up to that kind of person.

    For those nurses who might think, “Gee, I wish my pt/fams would open up to me more… perhaps tell me about their innermost thoughts & feelings, or maybe even about their “near death awareness” types of experiences… I would suggest that the best way to nurture that possibility would be to work on your self. It may seem a little counterintuitive that working on one’s self might encourage more openness from others… but that starts getting into the whole issue of the connection between ‘I’ and all of humanity (we are all connected.) However, if one begins fostering the habit of looking honestly at one’s self, pt/fams will sense that and feel safer spilling their guts. In school they teach what phrases to state or what leading questions to ask, but it is not so much a question of how to manipulate someone into opening up. Rather, it is more a question of how to render one’s self less threatening… so that the pt/fam will open spontaneously (as opposed to being manipulated or tricked into opening up via the employment of some clever ruse.) To whom would you be more inclined to open up… someone with a name tag that says, “You can speak to me,” or someone in whose face you can see and sense evidence of their having felt the pain of self-awareness.

    When a person works on self-awareness… learns to see their self more clearly and honestly… they simultaneously become more adept at seeing others more clearly and honestly. In other words, to gain skill at seeing through your mask I must first work at seeing through my own. The better I get at seeing me, the better I get at seeing you. Being around dying people can be sort of spooky in that regard, for they are being forced to see themselves more clearly… which means they may well be able to see right through you too.

    Keep in mind that all of these things are merely trends. The dying TEND to become more self-aware, but from individual to individual that tendency may vary from “quite a lot” to “not at all.” On the whole we are inclined to become RELATIVELY more self-aware while dying, but if one had virtually no self-awareness to begin with any progress made in this area might be virtually undetectable… or it might be striking, depending on the individual.

    In a peculiar sort of way, this provides yet another clue that life must surely go on (after death.) It suggests that even if we do not make much progress in our personal growth here in this lifetime, we will still have time and opportunity to keep working on our self after death. It is only a clue… something implied by the prevailing circumstances within our limited purview… yet it is compelling. If, after all, the average person’s success in achieving truly laudable levels of personal growth in a single lifetime were the measure of human achievement, humanity might well be viewed as one of the universe’s more spectacular failures. This alone is highly suggestive of further opportunity for redemption; i.e. that death does not end life. Or, to put it another way, “You ain’t gettin’ outa here that easy Pal. Everywhere you go, there you are, so you might as well start getting acquainted… with your self that is. You can do it here or you can do it somewhere else, but do it you will… and the quicker the faster aye?”

    Now, changing directions just a bit, I shall again raise the haunting question: When dying people are “unconscious,” are they working? Are they processing? Is it situational? Of all people, hospice nurses must have opinions on this issue.

  3. by   zenman
    I've been asked to participate in this thread (wow a long one!) and present the shamanic point of view of death. Many people grow up with the idea that you will go to Heaven if you are good and to Hell if you are bad. These concepts are European; for shamans there is no supernatural heaven. There is only the natural world, with visible and invisible realms, including the Spirit world. We also live in a benign universe - there is no evil principle. There is no predatory outside force that we must be on guard against.

    When the missionaries began preaching about Hell, the Indians asked where it was. The priests told them that it was not in the visible world but pointed toward the ground. This really confused the Indians as they understood that all life comes from the Earth.

    We also do not believe in being cast out of Garden of Eden. We are the caretakers of the Garden and will never have dominion over it. The native Indians were also confused about woman being born from man as it goes against nature. Everything is born of woman. You guys rule!

    I don't study comparative religions but have read that all of the world's religious stories share a common source in Nature - worship of the sun and solar system. The great religions then personified the natural forces into human-like deities. Ex., the story of a son-savior is duplicated in every major religion, even thousands of years before Christianity. Persia's Mithra, Tibet's Indra, Egypt's Thulis, Mexico's Quetzalcoatl, Nepal's Iao, Syria's Thammuz, and India's Krishna are all counterparts of Jesus who were born of virgin mothers, had rulers that tried to kill them when they were infants, advised their elders at the age of twelve, started a three year long ministry at age thirty, and were killed on a cross.

    Shamanism is a spiritual practice, not a belief system. As such, you will find people from many religious faiths as well as those who have a real distaste for what religions have done. Your own spiritual or religious background will color how you die.

    Not that that a little history has been covered, death and rebirth experiences are very important for shamans. Part of our "training" is to die (this includes the death of our ego) and be "born again" in order to master our practice and be fit for the rigors of shamanic work. This can be a powerful experience. During my death rite, which included two physicians in the group of four people lifting my energetic body away from my physical body, I didn't want to come back. One of the physicians had to call one of the shamans over to bring me back. Probably one of the few times a physician has done that, lol!

    We also perform death rites for those who are dying. There are three steps: recapitulation and forgiveness; granting permission to die; and the final rites. A shaman is called to guide others when they are sick or dying. The person calls on the Authority of the shaman because the shaman has a relationship with the spirit world. This Authority granted to the shaman is not the same as the Authority of a western physician. The western Authority focuses on the personal power of the physician, while the Authority of the shaman focuses on the personal power of the patient.

    The body knows how to be born and it knows how to die. I feel people should be allowed to die at home if possible, in their own comfortable environment. Respect the wishes of the dying person and their family. DC any unnecessary invasive procedures and keep the person comfortable. Make the transition as easy as possible.

    I'll elaborate if needed.

    A little story about an internationally known neurosurgeon on trip in Peruvian jungle talking with Shaman:

    Neurosurgeon: And what do you do?

    Shaman: Well doctor, I have my flock of Lamas and I raise a little bit of corn and I do a little bit of healing. What do you do, doctor?

    Neurosurgeon: I will cut open a man's head and cut through the bone and pull out a tumor the size of a walnut, and throw it away and then sew their head back up and that man will live. Can you do that?

    Shaman: No doctor, I can't do that.

    Neurosurgeon: Well, what do you do then?

    Shaman: Well doctor, if someone dies and it's not their time yet, I can follow their soul through the first, the second and the third level of the spirit world and right before they arrive back home I can catch it the way one catches a butterfly and bring it back and blow it back into them and they will live. Can you do that?
  4. by   req_read


    So what do you think? When dying people are “unconscious,” are they working? Are they processing? Is it situational?

  5. by   Allow Mystery
    Thanks zenman, interesting philosophy!
    May you recommend some 'further reading'
    on Shaminism and more particular "death rites".
    As a Hospice Nurse, I have developed my own
    philosophy, and "spiritual practice", and also
    believe that "the body knows how to die", people
    should be allowed to die in a comfortable environment
    with a loving presence, with the least medical intervention,
    and my 'job' is to facilitate the smoothness of this transition.
    Peace, Shamu (isn't that a whale)
  6. by   finn11707
    There is much to learn in your post--thank you for presenting your knowledge here. I was pleasantly suprised to read that many religions have the commonality of a Son Savior. We cross many cultures and faiths in our practice of Hospice work, depending on where we practice, of course. This information is useful. I always have believed that one's particular religious beliefs--even if not fully lived out in day to day life, will naturally affect the dying process-- especially ability to do forgiveness work.

    I too assure hospice patients and families that the body knows...knows to live, how to transition and how to die. The inner work is ours--to review our life, honor what is worth honoring, assess how we have cared for our life and finish the unfinished work. I believe most westerners need much help soothing fears of the transition of dying process and crossing over. The help needed is often towards a kinder understanding of what lies beyond and how to finish what is not completed in relationships. Whether it is true or not, I find it helpful and healing for those dying and for their families to understand the 'sleep period' before death occurs is a time of learning, life review--completion time, which prepares and also gives glimpses to what lies beyond. There are many stories out there...near death experiences which have been life changing in that then the fear of dying was quieted. Death and rebirth rituals and stories can certainly be profound and meaningful for man's soul. Even those dying who do not believe in life after death, want to hear such stories and want to believe. I had a man who did not believe in life after death, yet, when he was dying, the hawk sitting for hours on his back gate was intrepreted by him to be his wife who had died before him.

    Do shamanic rites at the end of one's life also help to heal and complete unfinished work in relationships? Or is unfinished work a sign that the life is not yet complete?

    You mentioned in your story about the Shaman and the Neurosurgeon--the Shaman followed the soul (dying before its time) through the 1st, 2nd and 3rd level of the spirit world, to return it back home to the body. Is there then a belief that unfinished work keeps a soul longer in its body? It is often noted in Hospice work that a person who has much unfinished work lingers longer in the dying process. I had a woman tell me that she "would need a week or two at the end to complete her work". Though she appeared to be in her final hours on day one, she lingered 5 days, quiet, but actively fluttering eyelids

    I would be interested to hear more about what a "good death" means from Shamanic perspective.

    I would love to hear more about your personal death rite, Zenman, if you would honor us by sharing it.
  7. by   zenman
    Quote from req_read


    So what do you think? When dying people are "unconscious," are they working? Are they processing? Is it situational?

    I think something is going on until neural activity ceases and the brain shuts down.
  8. by   zenman
    Quote from Allow Mystery
    Thanks zenman, interesting philosophy!
    May you recommend some 'further reading'
    on Shaminism and more particular "death rites".
    My teacher, Alberto Villoldo has a good book that has the death rites in it. It's "Shaman, Healer, Sage."
  9. by   zenman
    Quote from finn11707
    Do shamanic rites at the end of one's life also help to heal and complete unfinished work in relationships? Or is unfinished work a sign that the life is not yet complete?

    You mentioned in your story about the Shaman and the Neurosurgeon--the Shaman followed the soul (dying before its time) through the 1st, 2nd and 3rd level of the spirit world, to return it back home to the body. Is there then a belief that unfinished work keeps a soul longer in its body? It is often noted in Hospice work that a person who has much unfinished work lingers longer in the dying process. I had a woman tell me that she "would need a week or two at the end to complete her work". Though she appeared to be in her final hours on day one, she lingered 5 days, quiet, but actively fluttering eyelids

    I would be interested to hear more about what a "good death" means from Shamanic perspective.

    I would love to hear more about your personal death rite, Zenman, if you would honor us by sharing it.
    The shamanic practice is designed to heal soul wounds, in ourselves first, and then in our clients. Yes, I think a person who has unfinished business tends to be bound to the earth and takes longer to pass over.

    A "good death?" A peaceful and gentle transition. Although I sometimes think about going at sea on a small sailboat during a storm, tied naked to the mast, with a bottle of wine in each hand, but then I like excitement, lol!

    Oh, darn! I just remembered. The Four Winds has a new website that hospice people might like to see and that might answer all your questions. Here it is (let me know what you think):

    Re my personal death rite. It's an energetic thing and experiential. The process can be described but won't mean much. It's different from the death rites described in the dying consciously website. It was peaceful and I didn't want to come back the first time. During another time I was aware that my head was falling over to the side, just like I was dying in a movie, and I'm thinking, "this is strange, just like in the movies!' Then the shaman started calling me back.

    This might explain things. I loved this story. Part of an interview. Link at end.

    "The second step is the work of the west, the work of the jaguar, and it's the place where you come to lose fear, and you lose fear through a very ancient ceremony of symbolic death, where you come to meet your death, and it's not talking about what it would feel like to die, or closing yourself off in a sealed box and going underground for a couple of days; no, it's done in a place of power. For example, let me tell you one of my experiences. We were in Machu Picchu, about to enter the City of Light of the Incas, and according to their traditions, you could not enter Machu Picchu until you had died, till you were a person that's already dead, that has no fear of death. There's a death stone outside the city, shaped like a canoe, pointing to the west, that the shamans would come and lie on, and would actually separate their physical bodies from their energy bodies, which would be launched to the west in a journey of symbolic death, taken by the spirit of this jaguar that came and took you, ripped you out of your body, and took you through a complete circle around the earth and brought you back from the east. Well, I always thought this was a very nice myth -- you know, the spirit of the jaguar coming and pulling you by your hair and going off to the west, and you going out of your body."

    MISHLOVE: "Kind of quaint, even."

    VILLOLDO: "Very quaint, very nice myth, and something I'd enjoy telling my kids about. Well, the first time I did this, I lay down on the stone and this old, old medicine man I was with looked at me and he said, "Alberto, belief is not something that is based on proof, like your sciences. It is something that you invest. However much of yourself you invest in the ceremony is what you're going to receive. Don't be an observer; participate. Dare to take a chance." I said, "OK, I'll give it a shot." I lay down on the stone, and he began to put his hands over each one of my chakras, over each one of the seven energy centers in my body, and to chant into them, and then took both of his hands over my body and just -- whooooo! -- made this throwing motion. I was looking at it through half open, half closed eyes. I didn't feel anything. He called in the spirit of this cat to come and take me; nothing. At a certain point I feel that he's done, and I get up, and I walk back to take my place in the circle with the other people there, and I see that everybody in the circle is still looking at the stone, and I turn around and I look back at the stone, and there's my physical body lying there, and there's this medicine man turned towards me and he's saying, "Come on back here; get back in there."

    MISHLOVE: Get back in your body and start over.

    VILLOLDO: 'Right. So I go back into my body, and I'm going, what if I can't get back in? I'm at the same time very curious and intrigued and getting a little nervous, you see. So I wiggle back into my body, and he says, "OK, you can get up now." And that was how the experience manifested for me -- not this archetypal mythical journey with a jaguar, but what from my own cultural perspective was a separation of my essence, of my energy essence, from this material covering, which could only happen when you lose your fear of death. Because death is the glue that binds these two together, and fear, according to their legends, is the greatest enemy of the shaman. And once you let go of fear, you can begin to truly receive those lessons of immortality; until then it's just a thought. If you really experience disengaging from the physical and being conscious in that state, then everything else is just information, it's not knowledge."
    Last edit by zenman on Dec 11, '08 : Reason: Added stuff
  10. by   req_read

    The reason I raised the question about whether dying people may or may not be “working” or “processing” while “unconscious” is because that is a question which arises often for hospice nurses. It is quite common for hospice nurses to be approached by desperate family members and queried in pleading tones as to what they think is going on. I have contemplated this question frequently myself while caring for pt/fams, and on a personal level while contemplating the deaths of some of my own family members. The question is not only valid and worthy of consideration, but haunting and speaks to what we ought to strive for in assisting others as they die… not to mention, what we might aspire to in our own deaths.

    You have posted a fair amount of intriguing info regarding your spiritual preferences, most of it very general (non-specific to hospice practice) while casting aspersions on some European religious beliefs in the process. Not that many European religious beliefs have not earned defamatory comments, but the general tone of your posts seems to come down to, “My religious beliefs are superior to your religious beliefs.” And that is pretty much true for virtually all religious belief, among all practitioners throughout all time. After all, if people did not think their doctrines were superior they would find different ones (as you have apparently done yourself.)

    The point that I have labored to make throughout this thread (and in my other writings as well) has been that there is no single “best” doctrine… no one-size-fits all religion that works well for all alike.

    All people are connected, not only to each other but to all living things (which includes rocks & grass and our Earth Mother etc.)… yes, quite so… but at the same time every person is utterly unique. I am the one and only me that ever has been or ever shall be… and the same goes for you. Therefore, it would only seem logical that my spiritual views… my personal religion if you will… is just as unique as I. I am the only person who has or ever will have my personal spiritual perspective, perhaps largely because it has resulted from my own personal spiritual experiences and the feelings thus engendered. I pick and choose the rituals I perform, the beliefs I hold, the expectations I have for myself and for my place in the universe. They are a combination of European, Eastern, Western, Native and Ancient religious thought… with a healthy dose of superstition thrown in for good measure… plus a smidgeon of guesswork and plain old-fashioned bias. I do not proselytize my personal religion because it is mine and mine alone. Get your own, but keep your hands off mine!

    It is perfectly fine to compare beliefs, doctrines etc… as well we ought… but ultimately every individual must create his/her own personal religion… and hopefully, every person’s utterly unique religion would be based largely on what actually works.

    And therein lies the beauty of practicing hospice. When watching people die we are given the opportunity to see what actually works. Of course we are seeing it in others, but the information gleaned can often be extrapolated to one’s own unique set of circumstances. Indeed there is a wide range of nuance, but there are generalizations that can be drawn as well. For example, how do the deaths of those who actively seek answers for life’s essential quandaries while being respectful of their fellow humans compare with the death of say someone who practiced a get-everything-I-can-regardless-of-how-hurtful. Would the death’s of these two very different individuals be as different as they were in life? And if they did tend to differ, in what ways?

    Is conscious death better in some way than unconscious death? If so, why or how? And if it is, what types of behaviors, practices or beliefs prior to one’s own death seem to be more likely to yield conscious death? And if that is not attainable, what of unconscious death? Are people working and processing unresolved life issues while awaiting physical death unconsciously?

    That was the question posed. As I say, hospice nurses wonder about this often… not to mention, are pressed by family members, often hard, for answers. Somehow I don’t think distraught family members would find a great deal of solace in, “I think something is going on until neural activity ceases and the brain shuts down.”

    For hospice nurses dying is very, very practical. What actually works? What actually helps? When we are dying our hand has already been dealt, new cards may have been drawn and the unwanted ones thrown down. But it’s a little late to begin studying a new religion at that point… you play what you were dealt and hope for the best. And if you happen to be the hospice nurse standing there with a whole bunch of very upset family members pleading for some sort of helpful response from you, what do you say?

    As for eliminating or “dying to” ego and fear, that is a whole other set of issues. These are two of the most ubiquitous “usual suspects” when it comes to assigning blame for human suffering, and they usually receive pretty poor press. Religious zealots are wont to claim they have conquered both… but I cannot help but wonder. Upon reflection, we were given both… and one cannot help but ponder whether Divine Intent (by whatever name) must have felt they served some purpose… as obscure as that may appear from our current vantage point. After all, your vision of being lashed to a mast in a raging sea would hold little romance or drama if not for the presence of some fear and ego.

  11. by   finn11707
    Re --

    I think all the info and perspective in these sites is intriguing, pertinent and useful in our Hospice work. What I glean is naturally filtered through my own beliefs and experiences, but suffice it to say, most of the patients and families I have worked with in the dying process are calmed and helped through the process when supported toward 'spiritual' understanding that it is a sacred, healing time which opens us all to great learning and healing, if we desire it. By helping patients and families to create sacred space around the dying; by speaking to the 'thin veil' ...potential for seeing beyond...expanding consciousness which brings greater understanding and opportunity for healing resolution, we allow each individual to intuit specific meaning for himself. Self directing and reinforcing the meanings one needs to hold, to journey through the process and beyond, seems to be the greatest task and one which we are often called on to help with. The precious task of honoring the individual and family through engagement in life review calms most and gives us cues in how to support and guide for those who struggle. In hospice, the nurse is frontline--because of western medical model as payer--and yet is perhaps the least equiped, as far as formal training. That is the debate and angst behind voiced aspects in this lengthy thread.

    I believe we work best when we honor the 'mystery' surrounding death and allow the individual the task of assigning its meaning and what is needed to navigate and step through. Not exactly offering nothing, but guiding toward personal self discovery, by helping to 'set the stage' for learning.

    True, the way we engage the individual patient and family must vary according to where they are, what life they have lived, what personal meaning their death holds for them. But, the task is generally the same: easing the process by supporting the physical and psycho/spiritual needs of the individual; through offering our medical knowledge, where it fits; our presence to witness and honor, when it is needed, and our unbiased support of the parts of the mystery of dying that each individual chooses as his.

    I believe there is no one way to achieve a good death. I believe there is resolution work going on when a person lapses and lingers in an unconscious state. Perhaps something akin to the death rite -- stepping out of the body to learn something important.

    I believe westerners are curious about this unconscious state because it is beyond our ability to delve into, study and understand or know what is going on. We are forced to accept that we cannot know. We can only guess and our guessing is affected by our personal beliefs and experiences. Or, occasionally, we receive a personal account, by someone who had a near death experience and then remembered what they experienced in that 'other world journey'. Or, we wittness something as someone dies. We listen and observe with reverence and awe. We accept the experience or story into our self ---if it fits with who we are. Then, it becomes one of our stories when we are gathered around the fire, in the darkness of the night. Still, it is just information, not knowledge...until we arrive there ourself.

    We become one through the experience of attending the dying. One in the search for the meaning of living as it pertains to the part called dying.

    What I wonder most deeply is whether the quest of western and eastern seeking is really so far apart? I admit, eastern philosophies are oft more forgiving and allowing of mystery which can help ease man's angst and nourish the soul. Perhaps this is why westerners are increasingly seeking out parts of eastern practices and beliefs.
  12. by   finn11707
    "...but ultimately every individual must create his/her own personal religion... and hopefully, every person's utterly unique religion would be based largely on what actually works."

    So true! Michael. Which is akin to my belief that the patient will lead, (if there is time, and we listen carefully) in which of his beliefs will support on the dying journey and which will require help to ease or reframe with the 'sacred mystery' frame. After all, the final hours of a person's life can cause some quick changes in their views and beliefs.
    Sometimes we come across a patient or family in hospice that makes us feel that nothing we do to support helps. We have all encountered patients who say "you can do nothing for me" or say the same thing framed into a question: "what can you do for me?" They know, on a deeper level, that we are not the lead. It is their journey and they must face it alone in the end.

    So perhaps, the best we may have to offer some is the mystery, and the stories which support the sacredness of the mystery--in its ability to teach us that there is something important beyond our knowing...framed in the possibility of acceptance, forgiveness, learning, love and resolution found in that unconscious, silent part of the journey.
    We don't arrive at the Hospice door knowing all the right answers, words and interventions to give. The hard part is that we stay open to the learnings and to the fact that we, as well as they, will need to intuit the meaning and the way in parts of the journey.
  13. by   leslie :-D
    zenman, i very much appreciate your links.
    have read the first one, will read the 2nd one a little later.
    however, i personally relate to the concept of shamanism...
    not really understanding the need for the rituals, i.e., addressing the 4 winds, heaven, earth.
    i think ultimately, all these philosophies of consciousness and spirituality, are generally similiar, with only metaphorical variances.

    relative to hospice, i think it realistic to do this work w/those pts who are receptive and curious.
    and whatever business is untended to here, it is inevitably resolved...
    there is no escaping it.

    while i do agree that we are comprised of energy fields, i struggled w/the concept of cleansing chakras.
    to me, that type of work would be mentally expended, rather than the physical means noted to different areas of our bodies.
    but i'm sure i am only showing all my ignorance on this topic.

    either way, thank you for your input.
    and i look forward to reading and learning more.