nettie01

Thanks a lot! not sure what Dakin's solution is but I will look up the generic name.

Hello All I'm writing from New Zealand and I really appreciate the help and advice I find in this forum. We have an elderly man with dementia in our LTC unit and, besides urinating on various pieces of furniture and the floor too he has a malodourous wound on his back. This has been assessed medically; he's had a course of antibiotics for that. My question for the forum is, what are you using these days for malodourous wounds? Are charcoal pads still being put onto wounds? Someone had the idea that "Kitty litter" under the bed may help absorb some odour. Thanks for any tips. Netty PS I will search the posts also, for comments about this topic

Hey thanks for that. I love nurses dot com. What I want to know is, is it acceptable where you work to use your bare hands to apply non-medicated moisturiser? I'm thinking, in aged care it's more "human" than using gloves. Ofcourse gloves for any broken skin or medicated cream: eg containing steroid. thanks Jeanette

Thanks a lot Jackson1951!!! I started this thread in 2005 so it's a surprise to see your post. It's all still up to date. thanks again Jeanette

thank you for all your comments. this site continues to be helpful and interesting. jeanette new zealand:nurse:

:yeah:wow!! i remember you guys! i participated in this thread back in 2006! i've been trying to work out where to 'break in' with my practical issue... it's all very interesting, your thoughts. thanks.... i'm writing to you from new zealand again. thank you for any advice from you experts. i'm a medical nurse currently working in long term care and i've found myself disagreeing with colleagues recently about when it's right to give morphine. i'm very happy to give morphine for pain, respiratory distress and perhaps anxiety but once i was caring for a patient who'd had a large stroke and was unconscious. the decision was made not to hydrate or nourish her - to 'let her go'. the doctor prescribed a morphine/antiemetic/anxiolytic mixture in a syringe driver but the patient looked peaceful and didn't appear to be in pain so i talked to the doctor who was happy for us to use the prescription when we thought fit. another colleague strongly disagreed and said i should give it to the patient, to keep her comfortable. i prefer to give medication to control symptoms otherwise i feel like i'm doing euthanasia. it seems to me that some nurses move into a mindset of "this person is dying now and we will do the thing we do for dying people - give them morphine." i don't like to sedate people unecessarily - they might still be able to talk to relatives. (perhaps not the pt in the example, but others may). thank you for your thoughts. i know the issue of conscious death/alertness has been covered. i guess if i just read all the pages of this thread i'd have all the info i needed! jeanette new zealand jeanette

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

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

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...

Wow! This forum is so cool! You guys are really helping me; I should come here more often. I came today to write about an event that bothered me... My patient on an acute medical ward had had a stroke and then extension and treatment had been withdrawn so she could die. On assessing her she looked comfortable, peaceful and asleep/unresponsive to voice/touch/turning. The doc had charted a syringe driver with morphine, anti-emetics etc. I didn't want to start it as there was no apparent pain/nausea and no respiratory distress. The patient's daughter didn't know what was best - she wanted us to decide. The doctor was happy for the order to be made PRN. But I clashed with a senior nurse (I'm not junior, just middling, been nursing since 1990) who said I should give it because the doctor had charted it and anyway it would help the pt with any possible symptoms! I really annoyed her (often do as I don't always follow her suggestions). I guess it would be very obvious to you people. I just give morphine for pain and respiratory distress otherwise I feel like I am doing euthanasia (which some pts want but that's another story). Thanks for reading Nettie New Zealand

Re: Managing symptoms for a “good death” Req_nurse thanks for your strong position as it stimulates thought and discussion. I'm surprised by your categorical definition of a good death; what if people don't want to be completely conscious as they die? I've found that the definition of a 'good death' varies with individuals. Nettie New Zealand

oh boy! thanks for your post. i'm shocked to read about this scenario. am i cynical to wonder what the family stood to gain by the man's death? to me it's quite clear - it's not a 'grey' case as so many are. he was alert and wanted to continue living. he had motivation and the ability to get up. he struggled to regain independance - this man had the will to live! i don't understand how other people were allowed to decide for him when you describe him as a person who could decide for himself. i'm accustomed to the principle that other people decide only when the patient has lost their ability to decide. i think your gut feeling was connected to reality. what you describe was clearly unethical - perhaps there are more facts in the case that you didn't mention? how could this happen??! ageism! thanks for your post! jeanette new zealand

hi thanks for your story. it sure does seem silly to have all that intervention. i think the hard thing for the decison-makers is knowing when to stop and then knowing that death will be the result. death is so alien to us - life is what we know about. thanks jeanette

oh, i thought it was quite clearly passive euthanasia - not treating something that could be treated and so allowing nature to take its course. that's not to say that all euthanasia is bad. jeanette

thank you, that's helpful. jeanette