Managing symptoms for a ï¿½good deathï¿½

req_read · Jan 4, 2007

Nettie…

Hello down there! I just exchanged emails with someone in Australia. She was heading to the beach with suntan lotion in hand and could see smoke coming from bush fires, so I sent her a photo of my patio furniture… buried under a foot and a half of snow. She said it helped her feel cooler.

You raise a good point.

First, the categorical statement regarding dying consciously can be equated with the categorical statement that it is preferable to live consciously.

Nurses often equate “consciousness” with a reaction to painful stimuli, but I am using it in the sense of being aware of who we are… which has largely to do with how well acquainted one is with the person hiding behind his/her own façade.

It has to do with being conscious of why you do what you do. How well do you know yourself? For example: You are a nurse. Why? What is it about you that made you want to enter a caring profession? What is it about caring for others that makes you feel good about yourself? How does that nurture your self esteem? Are you conscious of the potential pitfalls intrinsic to that method of enhancing self esteem? If for some reason you could no longer practice nursing (don’t laugh… it could happen… it did to me) how would you nurture your self esteem then?

In his ground breaking presentation on Family Systems, John Bradshaw quoted a line from, I believe it was the play- The Death Of A Salesman. The quote was (roughly): “The greatest tragedy of all is going through life and never knowing who you are.”

While these considerations may seem rather academic or vague in the work-a-day world, they have definite implications when we are dying. Take for example the “successful,” wealthy CEO who has been envied all his life… then it comes time for his dying process and he discovers he is really not “better than” anyone else after all. Worse still, he now realizes he has been motivated largely by greed. He enhanced his self esteem with greed. Now he is about to leave the physical realm with nothing more than his consciousness, and what he is now (perhaps for the first time) conscious of is that he has really not been successful at all, but rather, he has been shallow and selfish.

Now, this fellow may very well not want to be “conscious” while dying. Dying process forces… does not ask politely or merely suggest… it FORCES us to look at who we really are. This fellow may not want to look at that, so he is inclined to become “unconscious” if given the opportunity. However, the probability is that his “unconsciousness” will not last.

Which is the great danger of assuming death “ends” life. It probably does not. So those who suppose death will somehow relieve them of bearing responsibility for who they are will probably get a big shock in the proverbial “end.”

Consciousness is no easy burden to bear…

“His was a great sin who first invented consciousness. Let us lose it for a few hours.”

F. Scott Fitzgerald (1896–1940), U.S. author.

But easy or not… like it or not… consciousness is what we are. The categorical statement that it is best to die consciously is really no different than a categorical statement declaring that it is best to know who we are… as opposed to, it is best to nurture grandiose self delusions and live your life in a perpetual state of clue-less-ness.

And as always, the proof is in the pudding. Hospice nurses have front row seats from which to observe how this or that lifestyle and thinking pattern plays out… what works and what does not. This has nothing to do with ethics or morality, it has to do with what actually works. Hospice nurses see how people die… whether it occurs gracefully or with much suffering.

Keep in mind… suffering works as a learning tool. If someone says, “Don’t touch the stove, it’s hot.” You could exercise trust and good judgment and not touch the stove. Then again you could lay your hand on the stove and leave a few layers of skin hanging there when you jerk your hand away. Either way you learn. But all things being equal, most people would rather learn with a minimum of suffering. Therefore it is best for hospice nurses to observe what works and use that knowledge to assist their patients in achieving learning (dying) with a minimum of suffering.

Yes… some people would rather not be conscious of who they really are. If I lived my life the way some people do I’d rather forget about it too. But the question is: Is it possible to forget about it? Is it possible to never have to face your Self? Personally, I doubt it. But if you assume that death “ends” life, then perhaps you think differently. But realize this: If you make that assumption it is, in effect, a religious doctrine… not to mention, it is betting all your chips on one (rather doubtful) hand of cards. And the statistical probability is, your dying process will not be pretty.

Michael

Learning something that is both new and profound is nearly always frightening… which is why we try to avoid it.

req_read · Jan 4, 2007

Nettie…

As for your 2nd post (re: your stroke patient) I would be inclined to agree with your assessment. Trust your gut.

Michael

I’ve studied now Philosophy

And Jurisprudence, Medicine—

And even, alas! Theology—

From end to end with labor keen;

And here, poor fool! with all my lore

I stand, no wiser than before.

Johann Wolfgang Von Goethe (1749–1832),

leslie :-D · Jan 4, 2007

even though there are many pts who choose to remain alert to extent possible, there are also those who will readily opt for a cocktail of meds, to take away the 'pain'....meaning the physical, emotional/mental, spiritual pain.

so for those who choose the latter, that is a good death.

highly subjective, wouldn't you think michael?

what may be ideal to us, will make others run to the nearest train tracks.

we typically die the way we lived.

and so, if we lived our lives remaining as busy as humanly possible, not allowing one solitary moment to ourselves, we are not going to know how to handle the influx of feelings that we always tended to avoid.

that's where the marvelous world of pharmacology can work its' magic.

and i think that's the stark reality to many.

no one can expound on what a good death is, except the one who is dying.

leslie

req_read · Jan 4, 2007

Hi Leslie… good to hear from you.

When I speak of good death I am distinguishing between the specific and the general (in favor of the general)… or between the relative and the non-conditional (in favor of the non-conditional.)

For some, within the specific context of their situation, heavy doses of meds would be relatively good (relative to what their dying may have been like without them.) I have done it many times myself (given heavy doses) and induced very low levels of consciousness if not outright unconsciousness, and in some cases even death. Speaking specifically and relatively I would say that was, for those people, a good death. Speaking generally and non-conditionally however, I would not say that.

My fear (particularly among newer hospice nurses) is that meds will become their first line of treatment rather than an adjunct or a choice of last resort. The article that instigated this dialogue mentioned that the pt was depressed and wanted to know how she would die. To my way of thinking, the nurse should first have spoken with the patient about her fears and discussed probable dying scenarios (not an appropriate assignment for a SW.) If the patient wanted to know what her death would be like the nurse should have taken the time to discuss that with her. If that had not worked, then by all means get out the formulary. However, all too often, meds seemed to be the author’s first choice of treatment.

Meds are also useful adjuncts. Mitigating fear with meds can be very effective in getting a pt calmed down enough to discuss, and start working through, emotionally charged issues.

It is very true that we tend to die as we have lived. A favorite saying of a long-time friend of mine is: A tiger never changes his stripes. And that is quite true… or at least it is from the standpoint of statistical probability. Strictly speaking however, a tiger can change his stripes any time he chooses… figuratively speaking. Actually, tigers can’t, but people can.

Humans are possessed of a level of consciousness that permits choice. Once we become aware… or conscious of something… we have the option of exercising choice. If, like tigers, we operate on reflex, instinct or habit, we do not have access to choice… we just do it. That may be a statistical probability, but it is not written in stone.

With consciousness we have choices, without it we do not. Therefore, unless someone indicates, either by their deeds or words, that they do not want to be conscious, it is better to err on the side of leaving their options open… so as to maximize their choices.

Michael

Far too often the choices reality proposes are such as to take away one’s taste for choosing.

Jean Rostand (1894–1977), French biologist, writer.

leslie :-D · Jan 5, 2007

i can assure you michael, it is not just newbie hospice nurses who feel those moments of awkwardness.

in the most gen'l sense, why did we become nurses?

in its' most gen'l sense, i would suggest because many of us are familiar with the various aspects of suffering and so, we want to help. we understand.

my biggest fear, should i ever require hospice services?

that i'll get a nurse who fears death and so, knows how to make one die peacefully, via meds and maybe prayer.

what the nurse does in effect, is project their fears onto the pt and literally makes a good death-just so they'll appease themself in the process.

i'll get the nurse who doesn't even begin to understand "what was the purpose of my life?" or "i never became a Christian: am i going to hell?"

i'm talking about very basic and reasonable questions.

i'll get the nurse that responds with "here, it's time for your haldol, thorazine, ativan, roxanol or worse, "you shouldn't be worrying about that now. you have enough on your plate".

sadly and honestly, i truly don't think there are many hospice nurses that find comfort in the spiritual or existential.

i'm recalling one poster who suggested we post this thread under "new age".

new age?????

since when is discussing the qualities of one's life, new age?

since when is discussing the finality of death (on this earth), new age?

since when is perusing one's actions and inactions during the course of their life, new age?

i sit here in shock, albeit not yet speechless.

and i truly, truly hope i am not offending any of the readers here.

what i speak of is within its' most gen'l scope of consideration.

i am speaking of hospice nurses nationwide, worldwide.

although there are cultural differences, some things should be universal.

and that is to give our dying patients, their final say.

if they choose to talk about the weather, then have the grandest conversation one can muster, about the weather.

if they want to avoid, let them-never pressure them for something they're not ready or able to share.

but if they want to know what it's like to die- tell them the process.

but do be kind in sparing the undesirable details, if you anticipate someone will struggle.

even if they perceived themself to be a horrible parent, tell them they were loved-that they made a difference in their children's lives. (of course you need to know they made a difference in whatever they berate themself with).

there's always, always something positive to contribute.

i remember one time i was caring for a pedophile who had served his time in jail but knew, he just knew, he was doomed to hell.

how did he know?

because he was a Christian, God-loving man, and that he had upset our Savior very much.

i just stated the facts as i believed them: that God loves you, no matter how bad the sinner; therefore, you are worthy of love.

he asked me what my prayer for him was.

i told him i hoped that he had no memory of what he had done; and in his next life, that he would minister to underserved, rejected, abused children.

and i wished him good mental health.

he died, not fearing hell so much but rather, as if he might have a second chance. hopeful. re-energized.

as michael has been trying to say, there is so much we can do for our pts.

and anything less than our 100% best, merely serves to minimize the optimal dying experience.

we both lose.

leslie

nettie01 · Jan 5, 2007

Thanks Michael,

Your post is thought provoking. I appreciated Death Of A Salesman and relate to what you're saying.

It's refreshing to be able to talk about death in this forum when we're part of a "death-denying society" (Kubler-Ross); many in my immediate entourage don't want to discuss it. I think I know myself well when I say that my concern isn't for my own death - it's other people that I see dying in various states, sometimes in despair when patient and family are distressed - I see plenty of less-than-optimal deaths. For me, my faith is in "I am the resurrection and the life. The one who believes in me, even though he or she dies, will live. And everyone who lives believing in me does not ultimately die at all." (Christ's words, Message version)

I'm pretty excited about that and, (I don't often say this) but I'm looking forward to dying - and I'm not depressed. I'm happy to hang around 'til my name is called.

I see people who seem to have usefulness as one of their main values in life. They judge others who aren't accomplishing much, according to their terms. "He's no good, a bit of a no-hoper"; and then when they themselves become "useless" because of disability they get depressed and want to die because they're "Past their used-by date", no longer useful to the world, just a burden.

Well, I'm sure we're all familiar with that.

So I totally agree that we need more than our job (e.g. nursing) to nurture our self esteems.

Regarding being happy to die, I think it would much harder to live with (my worst fears) a dense stroke or tetraplegia than to die. But even in that my spiritual life (God) would sustain me.

But I don't have much success in helping people in their end of life transition. It's a real shame that many people die in environments not set up to help the dying - eg an acute medical ward where I work. The hospice service in New Zealand is a Cinderella-underpaid one.

I lamely ask if they want to see the chaplain. Often people say no, sometimes yes; many people are uninterested in formal religion. Social workers, yep. Sometimes I offer to pray for them, sometimes the offer is taken up. Many people I meet who are getting nearer death don't seem to have a decided approach. "I'll just wait and see" they say.

Leslie, I've learnt something from your posts thanks, e.g. about intractable pain actually having a psychological or spiritual root.

You're also reiterating what I thought:

"no one can expound on what a good death is, except the one who is dying. what may be ideal to us, will make others run to the nearest train tracks."

Now, about the physical aspect of dying (in reference to Michael's comments about conscious death), it's my simple observation that people go unconscious to some degree as they get nearer the Big Transition. It's not always because they are loaded up with sedatives either. I just thought (from observation) that's how it was. Haven't worked in a hospice though.

Jeanette

"The greatest tragedy of all is going through life and never knowing who you are."

Consciousness is no easy burden to bear...

req_read · Jan 6, 2007

What wonderful posts!! Thanks guys.

Leslie…

I laughed at your line: “…albeit not yet speechless.” I suspect speechlessness is not in your sign.

I got sort of choked up reading about your interaction with the pedophile. That was inspiring.

Shall we gird up our loins and discuss dying and religion? I’m all for it, but it would have to be done with the greatest of care… and realistically speaking, would probably attract a fair amount of nasty sniping and back stabbing (not an unknown phenomenon around these parts.)

Discussing religion and dying is kind of like lighting up a cigar while sitting on an open keg of gun powder. Then again, all hospice nurses see it (the effects of religion on dying.) Of course many “see it” within the context of their own beliefs and to one extent or another, see what they want to see.

Nettie…

You bring up a variety of issues… some hit rather close to home.

When I lost my eyesight I became “useless,” just like that. Working through that mind-set took years… and involved many poor choices (on my part) along the way.

Your line (nettie): “…it’s my simple observation that people go unconscious to some degree as they get nearer the Big Transition.” Statistically speaking, that is indeed the probability. But there are those instances (rare percentage-wise but common in terms of raw numbers) where that does not happen… where people actually do step out of this realm wide awake. Those are the ones who fascinate… who make your jaw drop and then ask, “My God!!! How did s/he do that?”

Another factor is this: You are more likely to see it (conscious dying) if you look for it. It may or may not be obvious.

From what I have observed, the people who do die consciously… perceiving where they are going I might add… tend to be people who know their Self… thoroughly. Which lends credence to the advice: “Know thyself and be free” (wherever that came from.)

Switching gears just a little…

The term “patient’s wishes,” in all its variations, is not always quite so clear. Let me haul a skeleton out of my own closet by way of illustration (I will try to be brief.)

Many years ago, while working Peds, I had a 16 yr old male with cystic fibrosis (affecting mostly his lungs.) He had watched an older sister die of the same malady when she was 18 yrs old. He swore he would not die that way… he swore he would not be put on the vent.

For his 16th birthday he got a car… and of course he wanted to fix it up; i.e. paint it. Well, inhaling a bit of paint was all it took to push his poor lungs over the line into the incompetent range. He was admitted to the floor where his status hung in the balance… and naturally it was at 0230 in the morning; i.e. my (night) shift, when he began to crash. At that point things happen fast. I asked him what he wanted to do. He gasped, “Intubate!”

I called the pediatrician… he said, “Call anesthesia.” I did, and just that quick this young man who swore he would never be put on a ventilator was transferred to ICU… on a ventilator… where he died about a month later… after experiencing all the horrors he had sworn to avoid.

Now I ask you… what exactly were that “patient’s wishes?” Were his “wishes” the ones expressed with calm, deliberate conviction? Or were his “wishes” the ones expressed in a moment of panic?

The next morning the pediatrician called the University experts. They told him he should never have put the kid on the vent. I can tell you it still haunts me some 26 years later. What say you? What should I have done?

Michael

And oh yes… by the way… one of the pitfalls of the “caring” mind-set is self-neglect… sometimes woeful self-neglect. Nurses are subject to this malady, so it is good to keep in mind.

Nettie… A lady in Australia began her email to me with “Crikey!” What does that mean?

nettie01 · Jan 7, 2007

Hi Michael

Thanks for your post.

"Crikey" is a common Australian exclamation that has recently come into focus because one of their popular and funny conservationists died dramatically and tragically when diving near stingrays - he got stabbed in the heart by the barb of one. Steve Irwin was known for his extreme enthusiasm; he did lots of TV stuff. He'd say "Crikey! Look at this beauty!!" (Meaning, Wow! Look at this big one - often a crocodile.) Here's a link: Australia Zoo - Crikey - Desktops

"Crikey" was his catchword. (and it's actually watered down blasphemy based on 'Christ').

You said: "Shall we gird up our loins and discuss dying and religion? I'm all for it, but it would have to be done with the greatest of care... and realistically speaking, would probably attract a fair amount of nasty sniping and back stabbing (not an unknown phenomenon around these parts.) Discussing religion and dying is kind of like lighting up a cigar while sitting on an open keg of gun powder. Then again, all hospice nurses see it (the effects of religion on dying.) Of course many "see it" within the context of their own beliefs and to one extent or another, see what they want to see."

Well I don't mind talking about religion and dying. I think I can see that I'm a product of my experiences and choices and environment just as everyone else is. I agree that we often see what we want to see etc.

From how I see it the USA has more religious people in it that NZ. We are quite secular here - many people are "practical atheists" i.e. God/ supernatural stuff doesn't figure much in their thinking. So I'm quite aware that we live in a post-Christian society and the cigar-on-powder-keg picture is a good one. Still, sometimes I lament the absence of a good talk about other-worldly things with people who believe other than me - but, understandably, it's often a 'taboo' door to open.

I'm keen though!

Having said that I'm about to go (in an hour) on a much-anticipated holiday - sun, sand, surf, heat, children, eating, reading, talking. I won't be lying in the sun though - that's against my principles! (We have a big ozone hole here so UV rays the worst - highest rate of skin cancer in the world I believe - here and Australia) So I'll be absent from my computer a week or so. I'll come back to you.

About people dying consciously, I'll certainly be looking harder for people dying consciously. I've heard stories of people seeing things/people and having looks of great anticipation, talking to people already gone on, having premonitions etc. My experiences are much more banal but I'll continue to hope.

About the 16 year old with cystic fibrosis you said:...

"Now I ask you... what exactly were that "patient's wishes?" Were his "wishes" the ones expressed with calm, deliberate conviction? Or were his "wishes" the ones expressed in a moment of panic?"

Oh, it's so hard dealing with a panicking person in the heat of the moment. I give them what they want if I can (what you did, as in what he wanted immediately). Actually facing death is different from the thought of it (apparently). So he wasn't really ready to die? Understandable at that age. Sorry, I'm not much help to you here. (I was going to write 'useless.')

Thanks for sharing about your eyesight...incredible...unimaginable.

About self neglect - I only work four days a week. I really look after myself with my ladies hours.

Jeanette

req_read · Jan 8, 2007

A wide range of interesting issues have been raised… where to start? How about with nurse’s self-awareness.

Dying (or living) consciously may seem a rather vague concept at first. But getting down to specifics can help to clarify.

For example: There are lots and lots of drivers on the streets. What percentage of all drivers would you calculate are “good” drivers?

Another example: As nurses we see, from the inside, how individual doctors conduct themselves. There are a few doctors we would go to if we were really sick. Then there are a whole bunch of doctors we would go to if we had the flue and just needed some basic meds. And of course there are doctors we would not go to EVER! So among doctors, nurses have a pretty good idea of which ones are “good.”

Now… one of the greatest difficulties in achieving accurate self-analysis is that it is hard to see one’s Self. It really is. Plus we are biased about our Self. Our knee-jerk reaction is to defend it, not analyze it (Self.) Therefore one of the keys to good self-analysis is observing the people around us, then assuming there must be some parallels.

So we see, and quite clearly I might add, that only a portion of all drivers are really “good,” and only a portion of all doctors are really “good,” so we must assume that only a portion of all nurses are really “good.”

Next… what makes them “good?”

Actually, I am using the term “good” more in the sense of being “exceptional.” Who stands out in hospice nursing? Who is exceptional? And what are the characteristics that put them in that category?

I would suggest that being in that select category requires a good deal more than just familiarity with the PDR. I would suggest that a good example of an exceptional hospice nurse would be someone who demonstrates love towards “the least among us,” say for example a pedophile. That is “worshipping God” by trying (as in- “working at it’) to be more God-like.

Unconditional love is a profoundly profound concept. Few can even grasp the concept much less practice it in tough situations. Many have difficulty conjuring up a reasonable facsimile of unconditional love towards even a “new ager,” much less a pedophile.

The pt in my experience who died most graciously (and consciously) told me that she actively worked (underline worked) at developing love… within her Self.) She said it does not come naturally. She told me that we aren’t born with it, we have to work at it. When we catch our Self not being loving, we must consciously choose to act differently. It is a choice one makes… and works at developing.

I would suggest that is what sets people apart… and since nurses are people, that is what sets nurses apart as well. And it has nothing to do with ethics or morality or what religious group you belong to. It is eminently practical. It has to do with what actually works; i.e. what behavioral and thinking patterns tend to yield a more gracious (as in- less suffering) dying process.

When I speak of “good death” I do so in the sense of one that achieves a certain degree of elegance… with a minimum of suffering… not only for the pt but for those around him/her as well.

Someone spoke earlier of “coming full circle.” What each of us brings to the proverbial table is our Self, and that Self emanates expanding circles of whatever it is we create in our personal reality… rather like dropping a pebble into a still pond… an ever expanding series of circular waves is broadcast from the center. Those who emanate a sense of love are easy to deal with… and amazing to observe. Those who emanate fear, shame, anger etc. are tougher to contend with… and far more common.

Dysfunctional people must “act as if” they were functional if they ever hope to rise above their learned, dysfunctional behavior patterns. In other words, their learned behavioral patterns have to be un-learned… which takes effort and time.

The average response to that statement usually goes something like: “Okay… I can accept that. All those dysfunctional people out there need to start “acting as if.”

But here’s the clinker… we are ALL dysfunctional.

Yes… that’s a fact.

So if we ever hope to rise above our own dysfunctionalism we must “act as if” we were not dysfunctional. We have to work at it. If we work at it long enough we may get to a point where it starts to come naturally… without thinking… when we “just do it” instead of consciously having to make that choice. I would judge that in Leslie’s case she has reached that point… the point where she just does it… no questions asked… no trying to act. And that, I would judge, is a true example of “worshipping God”… of working at being more God-like (as opposed to merely flattering God with our puny praise.) They say that imitation is the sincerest form of flattery, and working at imitating unconditional love until it starts to become reflexive is high praise indeed.

In a previous post I said Leslie’s interaction with a pedophile was inspiring. Perhaps now I have made it more clear as to why. I really am not impressed by someone who claims to “accept” Jesus (whatever that means.) But I am awed by someone who works at acting like Jesus… or God, or Allah, or Buddha, or the Great Spirit, et al.

No one can be forced to achieve conscious dying… nor should anyone be told they should try if they simply want to cross unconsciously. But for those who would like to try and would appreciate some guidance in making the attempt, it would help to have a hospice nurse who at least understood the concept.

Michael

Dying

Is an art, like everything else.

I do it exceptionally well.

I do it so it feels like hell.

I do it so it feels real.

I guess you could say I’ve a call.

Sylvia Plath (1932–63), U.S. poet. Lady Lazarus.

nettie01 · Jan 23, 2007

Hi Michael Interesting to read your post. I have been very stimulated in my thinking by it. Maybe my reply is off-line as I'm not talking about death anymore. If I should go elsewhere to write these things, can someone tell me? I like your comments about knowing oneself and how hard it is to see ourselves clearly - in fact we can't, so the suggestion that we observe others and draw parallels about ourselves is really useful. Your post made me think back to when I was 18 (25 years ago) and how I was hungering for a better Reality. I found Erich Fromm's "The Art of Loving" in a library and took a few "bites" from it (too hard to take all in) which really inspired me. From that time I wanted to know how to really love and be unselfish; incredibly it was a new concept to me I believe. I was conscious of how selfish I was and hated myself (for various reasons no doubt but that's the state I was in.) Yes, we are all dysfunctional to some degree. No-one is all wrapped up and water-tight; we all leak. I tried to apply the principle of wanting the highest good for the Other (the ultimate kind of love I believe, which Fromm talks about) by offering to make cups of coffee all the time for my flatmates. They got annoyed with me (I was a pretty young 18). The internal searching got desperate and then I believe the gracious Great Spirit of the universe generously showed me what life was all about. For three days I was free of fear and inferiority and self destruction and I experienced a powerful love and energy in which I was full of desire to love and help others. I saw people 'melt' and open up before and I want to say clearly that this love wasn't from me or from a decision I made to be loving. As you say Michael "Unconditional love is a profoundly profound concept. Few can even grasp the concept much less practice it in tough situations." and I don't know why it happened to me. I'm not going to say that I practice this love all the time - there are multiple lapses back into self-protection and selfishness. But I know where I'm going and what I want in my relationships with patients and everyone else. As you say, self-awareness and self analysis are necessary and also I think it's necessary to quietly and internally imbibe this Love moment by moment. It seems to me that there's a major fork in the road regarding the common belief about where the love comes from. I know there is a lot of love and kindness out there amongst people who don't profess a religion or other practice. Perhaps it's just that I personally (emotionally bankrupt, dysfunctional etc) was particularly weak in love and needed help from outside. (Yes, I need a crutch to live; I'm really happy with this crutch!) So basically, as I understand things, Humanism says we have the power within us to live and love (and I agree we do to a certain degree) but Christianity talks about a power from an external source - God. I agree it does take work and discipline and self-awareness as you say - in order for the love to flow freely. There are other theological concepts to fill in the whole picture of how it works for me, eg. Forgiveness, changing one's direction, but I'm not talking about those here. I once listened to a preacher who's life story was very inspiring (Leonard Evans). He was searching, searching, searching for a better reality. (He was already religious, a minister). His spiritual life was dry, he was desperate. He got to the point of saying, "Give me Reality or give me death." His testimony was that God said to him one day, "Love your wife." This was a major turning point for him and he finally understood that all through the years he'd been trying to love an invisible God who was the source of love (like turning on a hose and squirting the faucet instead of the garden) instead of the people who were flesh and blood in front of him - especially his wife. Happily he really practiced love after that and his wife was a very blessed woman. So obvious, yet so elusive. On the subject of husbands and wives, and back to my story when I was 18 - when I first went to a church (I was from a non religious background) my initial, unprejudiced response was, "Oh, it's not here! The Love isn't in Christianity, it must be somewhere else." Unfortunately many of the people in the church were 'asleep' spiritually (to my naïve assessment) and weren't 'practicing'. And the minister, I noticed, was quite offhand towards his wife but nice to us visitors when we went to his home. So there is the reason, I believe for a lot of the antagonism towards Christianity: we are all failures at it. Thanks for the quote by Sylvia Plath. A fascinating woman about whom I don't know a lot but her depression and despair come through the poems I've read (not many). I love TULIPS, Here's a link (http://www.angelfire.com/tn/plath/tulips.html) She refers to nurses in it, not to mention the wild, breathing, vivid, loud, emphatic tulips. Guess she had quite a bit to do with nurses. Here's the end of "Barren Woman": "Blank-faced and mum as a nurse." Hopefully times have changed! On a more positive note, "Make love your aim." - Paul, The New Testament Jeanette New Zealand

req_read · Jan 23, 2007

Welcome back Jeanette. The beach must have been pleasant respite.

The topic of spiritual views is eminently relevant to a discussion of dying process in as much as it has an inevitable effect on how one's dying process plays out.

On the other hand, I learned very early on that asking patients which religion they belonged to told me little or nothing about their personal, spiritual views.

As previously stated, on a couple of occasions I have had dying preachers confess (to me) their own lack of faith. I know of one preacher who told his son (a personal friend of mine) that he does not even believe in God... that God is no more real than Santa Claus... and he is a highly successful and respected minister of the gospel (although I am sure no one in his flock knows his personal views.) Some of my own elderly family members (avid church goers all) have told me they do not believe there is life after death... but explain that they go to church for social reasons. And I have dealt with patients whose membership in a religious organization seemed to have been influenced by that organization's reputation for providing hands-on assistance to its members when in need, while their personal views bore little resemblance to those of the church.

So it is clear that supposed or claimed religious affiliation is a poor predictor of personal belief, much less of probable dying process outcomes.

Thinking patterns that revolve around exclusivity and divine favoritism for one's religious group are inclined to yield poor results. For example; those who like to think that their religious affiliation entitles them to fearless death, someone else dying for them, God sending around a figurative limo to pick them up when He is ready, being greeted by hordes of virgins on the other side etc, etc, ad nauseum are shocked when none of those things come to pass.

Although I did not write it down at the time and have since forgotten who said it, one of my favorite quotes goes like this: "A man cannot conceive of a god any greater than himself." So when a self proclaimed sage speaks of a vengeful, hateful god who revels in playing favorites I am inclined to believe such statements represent that person's rather limited understanding of unconditional love, not God's.

On the other hand, thinking patterns that are open, inclusive and loving tend to yield far better results.

One could argue the merits of this or that religion and never reach a definitive conclusion (as humans have been doing for thousands of years.) Then again, one could watch the dying to see how particular religious/spiritual beliefs play out in the proverbial end and obtain clear objective data.

One of the keys here is distinguishing between "religious" and "spiritual" views. Leslie said it best when she remarked, "i've always viewed religion as something learned and spirituality as something felt." (Her comment was made in the thread titled: "What's the difference?" I am sure you would find it interesting... it is about 6 pages back.)

I believe (Jeanette) that you are much better read than I. I am merely a collector of quotes. I used to read more (when I was able.) Now I look for the bare essence of things as expressed in a brief phrase or two. And my observations of the dying have lead me to the conviction that it is not what one says that matters (the façade) but rather what one does (the real person hiding behind the façade.)

"Forgive! How many will say, "forgive," and find

A sort of absolution in the sound

To hate a little longer!"

Lord Tennyson (1809-92), English poet. Sea Dreams.

The Earth was not set aside for the especial use of perfect people. Everyone here is flawed. And one of the most obvious of our flaws is our inclination to hate our flaws in others rather than working on them in our self. All of which is interesting in an academic sort of way... until we are dying. At that point the application becomes shockingly empirical; i.e. we discover, because we are all human, that the results of hating human foibles in others is virtually indistinguishable from self-hatred. And self-hatred yields poor results while dying.

Practical applications of all this might include things like (by way of examples)...

If a hospice patient boasts of his religious beliefs (early in his dying process) and seems inclined to think he will receive special privileges because of it, keep some sedatives and anti-anxiety agents in your back pocket for when reality hits. And if you have the time, try to be there near the end... he will probably need you.

On the other hand, if a patient has demonstrated openness, acceptance, a loving attitude and have worked through the seven stages of transitions, they will probably do quite well on their own... although you might want to consider visiting and perhaps witnessing something special.

Michael

"The human mind is inspired enough when it comes to inventing horrors; it is when it tries to invent a Heaven that it shows itself cloddish."

Evelyn Waugh (1903-66), British novelist. Ambrose, in Put Out More Flags, ch. 1, sct. 7 (1942).

BeExcellent · Jan 25, 2007

Sorry I haven't read each and every entry here but I agree with Req_Read posting way back in 11-06. I very much miss the very real and dignified process of conscious transition to death that included everyone; pt, family , friends, pets and yes, even the hospice team. Early Ram Dass should be on the on the reading list. I will leave Req_ Read to tell you who THAT old coot is.