Wednesday, October 04, 2006

Your Truth: Chemical vs. Physical Restraints

Another hypothetical scenario for your consideration...

This patient is an 86 y.o. female with dementia who is actively dying. She has become delirius, but still has the strength to get out of bed and is at a high risk for falling and injuring herself from the fall. In addition, she has a intravenous (IV) line that is being used for pain medicine that she keeps trying to pull out. The doctor has suggested the use of sedating medications to keep her from pulling out her line and from falling. But the family states they would like to keep her alert and thus they refuse the medications offered. Instead, the family prefers that wrist restraints are applied, tying the patient to the bed rails to prevent falls and to prevent the IV from being pulled out. NOTE: Both types of restraints are avoided while the family is visiting, but the family leaves to sleep at night.

1. What education could be offered to the family to ensure they are fully informed of the options to ensuring this patient's safety?

2. What other options might be considered beyond pharmacological or physical restraints?

3. What are your own feelings about chemical verses physical restraints and how might these feelings impact your attitude towards this family's decisions?

Sunday, August 27, 2006

Grief - the Written Word

As I've mentioned before, JennyNYC and I have been working on a poetry project where we write a poem a day to one another. We are now up to about 115 poems. Though I haven't been keeping up to the every day pace the past week or so, I am still getting a lot out of the experience - both in expressing some of my more uncomfortable emotions creatively and in the inspiration that has come from reading Jenny's words. This is one of Jenny's more recent poems that she consented to letting me post on this blog.

by Jennifer

A mother comes in one day at the end of her rope.
Her two ten year old twin boys,
who I've been seeing for therapy
along with their mother,
are driving her nuts.
"Ever since their dad died
it's gotten worse and worse!" she explains.
"Their dad used to make all the rules
and make sure the boys followed them.
Now there are no rules,
and it's gotten out of hand.
They're nice boys
but I can't live this way."
The mother and I sit down and think up rules.
I tell her to stick with the basics,
both for rules and for consequences.
The boys join us in my office,
and we talk about how it is at home.
It turns out they don't like the chaos either.
Then I bring up the rules,
and after reading a few of them,
like, "No cursing,"
and "Brush your teeth before bed,"
the twin who is usually the unemotional, "tough" one, Sean,
throws himself onto the floor,
curls up into a ball,
and begins to sob.
It's late evening in the clinic,
and his lone, heartwrenching cry
fills the empty hallways,
as the three of us listen and look,
frozen witnesses,
shocked, worried, and awkward.
Sean's twin, Johnny, says, "C'mon, Sean,
these rules are easy," but Sean can't hear him,
lost in a painful moment.
Johnny muses aloud,
"He's crying more than he ever has
since Dad died."
Johnny and the twins' mother
slowly ease themselves to the floor beside Sean
and put their arms around him.
Knowing Sean's usual distaste for physical affection
I tense up, fearing that Sean will lash out at them.
But instead he allows his family to hold him
providing comfort and sharing in the painful knowledge
that his father is not coming back.

This is such a beautiful and moving poem. I can relate to this trigger for grief from my own personal experience with my divorce. I thought I'd worked through my grief, as my divorce happened over six months ago now and I've started dating and just generally feel much more centered and like myself again. But then my childhood best friend's grandmother died. She was a big part of my childhood. She was rather eccentric and being around her always put a smile on my face. Since my maternal grandmother died when I was young and my paternal grandmother lived in Florida (and was still living up a wild, youthful life), this friend's grandmother was much like a grandmother figure to me. But the trigger that came from her death had nothing to do with her really. I wrote and sent a condolance card to my childhood best friend. As I went to sign the card, I faltered. I hadn't signed a card since the divorce. For nine years, I had sent dozens and dozens of birthday cards, anniversary cards, graduation cards, and such - all signed with my name and my ex's. This was the first time I signed a card with my name alone. Alone. Solo. In moments like this, the last six months feel surreal, like a dream. How my life can change so drastically from the life I lived over the last nine years. I spent nearly a third of my lifetime with my ex. The things I am grieving are manifold. On top of the loss of the relationship and the family we had become, there is the loss of an identity - the loss of that "Me AND You" at the end of those cards.

Friday, August 18, 2006

Your Truth: "I Want to Drive Her Home."

"Your Truth" is a series of posts I have written describing end-of-life scenarios. These scenarios are in some way controversial - either due to an ethical dilemma or a particular communication challenge. Please read the scenario and then offer your thoughts on what you might do in this circumstance. Although these scenarios are all based on real-life situations, they are fictionalized so as to protect the anonymity of the person(s) whom the scenario was inspired by.

In this next scenario, we have a 82 y.o. Russian female who had a stroke that left her non-responsive (she is unable to speak nor move and her gag and corneal reflexes are absent). She had end-stage renal disease prior to the stroke. She is still in the hospital. The doctors have given her a prognosis of days to weeks to live. Her family, per her written advanced directive wishes (rare to have these done, but sometimes we're lucky enough to know what the patient would want), has decided to stop dialysis and start her on hospice care. The family would like to take her home to die.

The family is afraid, however, that she will die during the ambulance ride home. They are strongly opposed to her dying in an ambulance and so they would like to drive her home in their minivan. Despite education regarding the perceived improved comforts that would come with the ambulance ride (bed, pain medicine, gurney ride into the home), the family remain committed to driving her home themselves.

Now keep in mind that the minivan is not equipped with a bed and the patient would have to be phycially lifted into the minivan. Due to hospital liability issues, the nursing supervisor reports no hospital staff may help her into the van and therefore the patient must be transported home by an ambulance.

What might you do? What are the potential positive and negative ramifications of either option?

Friday, August 04, 2006

The Death Penalty

My blog is about death and dying, in general. But also as death has pertained to my own personal life. This has led this blog to focus largely on the issues of:

-symptom management
-issues with facing mortality

...and more.

Today, I met a paralegal who works for an attorney defending prison inmates on death row. I am opposed to the death penalty, personally. I have been opposed to it primarily on the basis of its misuse - the fact that those whom are executed are disproportionately minorities.

Inspired by my conversation with this paralegal, I decided to check out what the death experience is like for these prisoners. Having read about the actual process of euthanasia (that's really what it is) used in these cases, I feel even more strongly opposed to the death penalty. I will attach the link here, but I caution you, the descriptions of methods of execution found here are profoundly disturbing.

Monday, July 31, 2006

Expired Poem

JennyNYC and I have been working on a poetry project. We have been writing one another a poem every day for 100 days now. I think part of my silence on this blog has been due to this new creative writing outlet. But I thought I'd share the poem I wrote last night. It's not my best piece of writing, but the subject certainly seems pertinent to this blog.

"Don't leave me,"
he nearly begged
in fear
as he reached out his hand to me.
His frail body was failing him.
His wife at his bedside
spoke the feeling
they both shared.
"I was scared."
She says the words
with her back to me
as she walks away from the bedside.
I massage his feet
to calm his nerves
and he falls right to sleep.

Two nights later,
I return to work,
looking forward to seeing him again.
Having bonded over the
touch of his hand in mine.
Having felt a connection
in his need for my companionship.

As I walk onto the floor,
my heart sinks.
His room is vacant.
The note on the clipboard reads,
"Transfer/DC to:

Tuesday, July 25, 2006

Thank you, Advance for Nurses!

Just a quick thank you to Terri Polick for including me in her recent article on nurse bloggers in Advance for Nurses.

Monday, July 24, 2006

from The Mystic Odes of Rumi via the 5th Season of Six Feet Under

Our death is our wedding with eternity.
What is the secret? "God is One."
The sunlight splits when entering the windows of the house.
This multiplicity exists in the cluster of grapes;
It is not in the juice made from the grapes.
For he who is living in the Light of God,
The death of the carnal soul is a blessing.
Regarding him, say neither bad nor good,
For he is gone beyond the good and the bad.
Fix your eyes on God and do not talk about what is invisible,
So that he may place another look in your eyes.
It is in the vision of the physical eyes
That no invisible or secret thing exists.
But when the eye is turned toward the Light of God
What thing could remain hidden under such a Light?
Although all lights emanate from the Divine Light
Don't call all these lights "the Light of God";
It is the eternal light which is the Light of God,
The ephemeral light is an attribute of the body and the flesh.

...Oh God who gives the grace of vision!
The bird of vision is flying towards You with the wings of desire.

Sunday, July 02, 2006

Symptomatology: Itching

For a list of symptoms I have reviewed in previous posts, please go to this symptomatology of dying link.

The next symptom I will address is itching (also known as pruritis). There are a number of reasons people who are at the end of life may experience itching. Some of the most common causes include:

-side effect of opioids
-uremic itching secondary to kidney failure
-jaundice secondary to liver failure and/or biliary disease

If the itching is presumed to be from opioids, then switching to a different opioid may be effective.

Uremic itching is more difficult to treat. The exact physiology of the itching is as of yet poorly understood. Therefore treatment approaches may move forward through trial and error.

Some of the medications that may be trialed for uremic itching and for itching related to liver failure include topical products such as:
-hydrocortisone cream - this antiinflammatory is very mild. If it's not effective, stronger steroids such as betamethasone 0.10% 15 grams twice per day may be used. However keep in mind that the stronger steroid puts the skin integrity at higher risk of breakdown.
-Lidocaine ointment 5% which numbs the surface of the skin.
-Sarna lotion, which is Camphor 0.5% and Menthol 0.5%, cools and moisturizes the skin and may help with mild itching.

Some oral medications that may be trialed include:
-Atarax (25 to 100 mg four times per day) is an antihistamine used to treat anxiety as well as for itching. It is primarily used for itching due to allergic reactions, but may be helpful with other types of itching.
-Benadryl, like Atarax, is best for allergic itching, but may be trialed as a supplement to other modes of treating pruritis. Antihistamines also make you sleepy. Some patients may report some relief if they are able to sleep through the itching.
-Questran (aka cholestyramine) is prescribed specifically for itching related to liver failure. It binds to bile acids in the intestine. This prevents their absorption, and the cholestyramine/bile acid complexes are eliminated in the stool.
Ursodiol (300mg twice per day)is a bile acid used to dissolve gallstones. Because it dissolves gallstones, it is suggested that it may also help with itching, but the effect is minimal.
-Doxepin (25mg daily) is an antidepressant/anxiolytic medication that has been used for pruritis. One of the side effects of the medication is peripheral neuropathy, which may be why it's been tried for this use.

Small studies have suggestd acupuncture may be effective in treating uremic itching in patients with chronic renal failure. Whether or not this may extend to patients at the end of life has not been studied.

See this link for more information on over-the-counter products for itching.

Saturday, July 01, 2006

Ethical Issues at the End of Life

If you are a regular reader of my blog, then you likely know that I have a passion for ethical dilemmas. Perhaps you even participated in a debate on one of my Your Truth posts.

I was recently asked to give a lecture on Ethics at the End of Life. Although I am passionate about ethics, I'd never given a lecture on the subject before. Having recently graduated from my Master's program, I dutifully prepared Power Point slides on concepts such as autonomy and choice, advanced health care directives, medical futility, quality of life, double effect, the spectrum of hastening death, moral distress of nurses, and the four-box method.

I *love* to teach. And no matter what the subject is, I always maximize interactivity between myself and my audience. Personally, I learn best when I am awake and I have a suspicion this is true for others. ;-) Fortunately, ethics is a subject that easily lends itself towards a lively discussion.

I have been wading through my email inbox, now that I'm done with school. I apologize to those of you whose emails have been sitting unanswered. I'm doing my best to get through them now. During this sorting of emails, I came across a link to an on-line excerpt from William Colby's book, Unplugged, where he writes:

"When surveyed, the majority of us say that when our dying comes, we hope to be at home, free from pain, surrounded by loved ones, and not hooked up to machines. In the abstract, that's likely true. We also very much want to be hooked up to those machines right up to the very moment when the doctor is sure that those miraculous tools can't fix us. Trying to find that exact line is no easy business."

This thought seemed particularly relevant to my last blog post, as well as to the discussion / lecture I gave this past week.

In the 1970's, it was accepted practice that any and all interventions should and would be taken to prevent death no matter how extreme the intervention (Drought & Koenig, 2002 - no, I'm not old enough to be speaking from personal experience, so yes, I used a reference for this). But as technology has advanced, we have vast and ever-growing means of keeping people alive, even while their bodies are otherwise failing them. As a result, ethical considerations in making decisions about treatment have become increasingly complex. This was a point I stressed in my talk; William Colby speaks to this in his book as well. Although technology has advanced dramatically, we are still no better at predicting when death will come. In my post asking how you'd like to die, not one of you said that you wanted to die hooked up to machines in the ICU. Why or why not?

If given the choice - to be kept alive as long as possible, but then to die in the ICU connected to machines or to possibly die prematurely but die peacefully at home, which would you prefer?

Thursday, June 29, 2006


Before I walk into a patient's room, I take a moment to gather myself. I take a few deep breaths and center myself. I am very conscious not to bring any stressful or hectic energy with me into a dying patient's room.

Today, as I was meditating, I felt that same shift. I felt myself coming to my center. And it occurred to me: I'd never practiced this same "presence" for *myself* before - I've only done it for my dying patients. What if I practice "presence" in all of my interactions? Okay, well, that may be an unrealistic goal, but how lovely would that be? Being present for myself this evening was incredibly powerful.

The power of presence has been discussed and written about in all kinds of disciplines - from Buddhist teachings to nursing research (unfortunately, I cannot put my hands on the nursing articles I have in mind).

So often, new nurses shy away from dying patients, citing, "But I don't know what to say!" Being present and bringing compassionate energy into the room is far more effective and valuable than any words.

I have decided to spend some time focusing on my spiritual practice. Since my divorce with S, I've felt rather off-center. First there was the major adjustment to living alone for the first time in my life (aside from one month back in 1995). Then I got involved in a whirlwind of a romance that crashed and burned as abruptly and as passionately as it shined. The sorrow over that second relationship ending within four months of my divorce gave me a new-founded shyness about relationships, which is perhaps just what I needed to step away from dating altogether to really spend some time alone with myself. I went on a few more dates to try to give it another shot, but recognized almost immediately that I was not fully present to the experience of the dates. I was frantically going through the motions of the dates to escape being present with my grief. So now, here I sit with myself. And the grief is far more tolerable than I had feared. Oh, the waves crash down on me pretty hard at times. But they pass and I am not running away from them all of the time. It's much less tiring to just sit still and feel.

So what does this new spiritual practice look like?

Well, it's not all about meditating. Today, after work I went on a bike ride in the park. The weather was lovely. Being surrounded by trees always feeds my spirit, as does writing on this blog. Surfing can be a spiritual experience for me as well - surrendering to the waves, the awe of the vastness of the ocean, my powerlessness.

Thank you all for listening / reading and thank you for coming back after my long bouts of silence. Now that I'm done with my Master's degree, I suspect I will be posting more often, once again.

Monday, June 19, 2006

How Would You Like to Die?

This question was asked on Jocelyn Ryder's Question of the Week email survey. The following answers were provided by her readers. Feel free to provide your own answer in the comments section of this post. If you are interested in joining Jocelyn's Question of the Week email list, please contact her directly at orangegrl13 at earthlink dot net.


Without getting too deep -- after *finishing* a big bowl of premium mint chocolate ice cream -- at peace, close to nature, and ready for a nice surprise.




i can say for sure how i would NOT like to die: in a car crash, a fire, by drowning, war, gunshot, stabbing, poison, (unless it was gentle, but not many are), or any other violent or otherwise painful death. ABOVE ALL, i would NOT like to die alone.

i think the way to go for me would be surrounded by loved ones, in a cabin, maybe, near a lake, a gentle cool breeze blowing through the window, rustling the flowers that are everywhere in the room, cat at the foot of the bed, dog nestled in my arm, my lover, my wife, by my side, holding my hand telling me she'll see me soon, that it's going to be alright, stroking my hair the way my mom used to do when i was a boy. and with the swell of love in my heart that would last the rest of her life, and a deep sleepy sigh of the dog, i'm gone.

i'd want to know too that after i go there would be a celebration, a party; and that all of our friends and family was there to say good bye in a really good way, to have fun with the life they still have, and love each other, if not for themselves, then at least for the day, to honor me.

i'd also like to be remembered. interesting. i get a pang of feeling like that would be asking too much for some reason. i don't really think it's asking too much.


I wouldn't like to die.


I would like to die peacefully. But only after achieving my goal of establishing my rescue/sanctuary so that it lives in perpetuity and to get laws established that would make animal cruelty a felony with a mandatory 10 years imprisonment and a mandatory $10,000 fine.


the thought of death is so scary to me that i have panic attacks about it; most recent thought and attack was yesterday

but if i must die, i would like to go in my sleep


peacefully while I'm dreaming. Hopefully after a life well-lived, and after I feel ready to go.


I would like to die in my sleep ... but would like to be very aware that I might "go" at any time and to have accepted that fate ... so I could still say my 'goodbyes.'




When I was younger, I always wanted to die by getting hit by lightening. I thought it would be such a great, dramatic end to a drama-filled life. Then my ex's uncle got hit by lightening and became a vegetable and I changed my mind - what if the lightening didn't do the job and I, too, ended up a vegetable? That would just bite. Now I'd prefer a slower death - like cancer. Something with a relatively predictable course, so I'd have time to say goodbye to loved ones. Preferrably not too drawn out, as I've always hated lingering goodbyes. So maybe metastatic cancer or pancreatic cancer (if the pain was well-managed). In terms of the other end of the hows - I'd like to be surrounded by loved ones and comfortable (pain, nausea, anxiety all well-managed). Oh! And I'd like to get daily massages for at least the last week of my life.


In my sleep at the same time as my husband.


Sober, and without pain (prolonged or otherwise).


Peacefully in my sleep. No dramatic exits for me! The most important thing is that its painless. I'm not afraid of death, only pain.


so trippy that you are asking that right now...i have
started reading the tibetan book of living and dying
because of some deep inner sense that was telling me
that i really wanted to learn HOW to die...don't know
why exactly that desire to learn about dying came up
in me, just trusted it...i am learning that death is a
process, that we can prepare for death by learning how
to live...learning how to live in our deep essential,
eternal self....through meditation, through remaining
calm through all the manifestations of mind....through
what the author calls 'calm abiding' that
term....calm abiding....not easy....such a worthwhile,
beautiful, i would like to die
calmly...really rooted in the light, in the truth of
who i am...deeply connected to my god self...i would
like to be very old and very content with what i have
done with my time on earth....i would like to be lying
in my warm, cozy bed in my home surrounded by family,
partner, children, grandchildren, animals....looking
out over the calm lake and beautiful lush green trees
and mountains that have nourished me so deeply...i
would like to breathe in, breathe out, breathe in,
breathe out, gently, with so much love and so much
gratitude and peace...transition softly, gracefully,
peacefully...that is what i would like....


In my sleep!


Not sure. I just don't want to be alone.


without regrets


Quietly (but not in my sleep – I want to know when I’m dying) at a very old age. Maybe I hear my great grandchildren running around downstairs. Maybe it’s very quiet, either way (selfishly) I want my partner by my side, holding my hand... Of course that means I won’t be there for him and that makes me sad... However I go I want to be satisfied. I don’t want to taint the experience with regrets...


something i never think about.

how i don't want to die: as the result of a street crime.


With as little pain and as much of my faculties as possible after a long life.
In my sleep and old is the answer I think.


i will
I won't


I would like to die admired, well respected, and in my sleep.


After a long life. With people I care about at my
side. Having done most of the things I want to try
while on this planet. Having loved much. Having made
soome kind of a difference. Having seen my kids
enjoying their lives and hopefully my grandkids too.
The thought of being seperated from my kids is very,
very hard-this is the hardest thing to accept about
death-that I can't be with them once I fly out of this
body. But more than anything, I want them to outlive


"Settin' " on the front porch in my rocking chair, holding hands with my elderly husband, and just nodding off.


In my sleep, after going to a party where I saw
everyone I loved.


Fly off in a little prop plane, two or three of us, and disappear--never be heard from again; no wreckage, or any other trace. Amelia Earhart style. Of course, this scenario also includes me being known by more people than just family and friends. I'd love to contribute to celebrity mystery deaths, like Rudolph Diesel going missing on a cruise across the English Channel, or Mallory vanishing on the slopes of Mt. Everest in the '20s. (They found him about two years ago--spoils the whole saga.)

That's just the PR aspect of dying, though--how I'd like it to look to the outside world. As far as what it would be like here inside my body...I guess I'll take the sudden heart attack. I'm out walking one fine day, and I slump over, and that's it. It might be nice to have time to say long good-byes to friends, but that means lying in a hospital bed with morphine racing through my veins. Not too wild about that.


And Jocelyn's answer...

Successfully defending a woman from being raped or attacked on the street. Preventing a child from being hurt or molested.

Or: laughing.

Saturday, May 13, 2006

Off Days

Sorry I haven't written the update to the last ethical scenario yet. In the scenario JP described, she states that the patient chose to stop dialysis of her own accord the following day and died within the next two days. This was over a weekend, so she was not able to assess how the family handled their mother's decision.

I will write more on decision making and family dynamics in a future post. You all had excellent thoughts on the situation. Thank you, as always, for your contributions to the dialogue.

I have had a few "off days" lately. It's hard for me to accept myself having an "off day." I'm suppose to be "on" and my best at all times. How did I know I was having an off day? Well, often I don't recognize them - especially their degree of "off-ness" until after the fact. I knew I was having an off day because I was finding myself particularly challenged by two anxious families. Normally anxious patients and even anxious families are a welcome challenge for me. But last week I was really struggling to find the patience to work with these particular families. I'm back working with one of these families again today. And here is how I see the measure of just how "off" I was. Today, I have one of these same families again. But this morning, I immediately reconnected with my sense of compassion.

In opening up my heart and mind and entering the patient's room with a fresh approach, the patient reciprocated and presented new information to me. Her son who has been so anxious will have no living family members once she dies, except for his wife. And his wife had a stroke five years ago - at the age of 46 - and has been in a non-responsive ever since. This new information certainly gives me perspective and a new appreciation for her son's anxious behaviors towards me. I am quite fond of the patient.

But as usual, I must also have compassion for myself. I can give myself permission to have "off days" now and then.

Wednesday, April 26, 2006

Your Truth: Decision Making Power

The following ethical scenario was proposed by reader JP.

As is custom, please read the scenario, share your thoughts or recommendations in the comments section and in a few days I will post a follow-up detailing the actual outcome in a related scenario.

Ms. Baker is a 84 year old woman with end-stage renal disease. She has been dependent on dialysis for the past ten years. She is currently in the hospital in the intensive care unit for sepsis (a bacterial infection in her blood). She also has a number of other co-morbidities including COPD (chronic obstructive pulmonary disease) and coronary artery disease.

When you walk into the room, the dialysis nurse pulls up to the bedside with the dialysis machine. As it appears, Ms. Baker tells you, "I am so miserable. It is so unfair that I have been so sick. Do you know the meaning of misery?"

The notes in her chart say that the family and the patient have decided on a DNR (do not resucitate) code status and have been made aware of her poor prognosis. You notice on the monitor that Ms. Baker's blood pressure is only 84/43. This is a very low pressure and the dialysis will likely drop it lower.

As the health care provider, you accept the responsibility for ensuring Ms. Baker is aware of her options. Accordingly, you say, "Ms. Baker, you can refuse dialysis at any time. It's actually a very peaceful way to go. You just fall asleep and don't wake up again."

Ms. Baker looks contemplative and asks, "Is that so?"

You assure her it is.

Ms. Baker looks thoughtful for a moment more. "Well, I want dialysis today."

When you leave the bedside, you search out the patient's children. When you find them, you explain to them the converation you had with the patient and why - she seemed miserable; her prognosis (as they know) is very poor and she should understand what her options are. The family is very angry that you have had this conversation with their mother and go so far as to tell you never to visit the patient again.

Some questions for your consideration:

1. Should patients be informed of their options?
2. Should families have the right to withold information from a patient?
3. How might you handle this situation from here?

Saturday, April 22, 2006

Symptomatology: Malodorous Wounds

I have been slowly making my way through the symptoms experienced at the end-of-life. The next symptom I would like to address is the malodorous wound.

People may have malodorous wounds for various reasons throughout their life. However, there are certain wounds seen more often at the end of life. Some of the malodorous wounds seen at the end of life include bedsores and fungating breast cancer lesions. The odor is caused by anaerobic bacteria in necrotic (decaying) tissue, which release volatile fatty acids as a metabolic by-product.

The odor can impact the quality of the patient's life and may lead to social withdrawal, embarassment, shame, and psychological distress.

Some possible interventions for managing these wounds include:

-Cleanse the wound with water or normal saline.
-Metrogel 1% applied to breast cancer lesion daily and covered with an occlusive dressing (such as vaseline gauze). Metronidazole (the active ingredient in Metro-gel) may also be taken orally. The oral form is less expensive, but the few studies that have been performed have shown marked improvement in odor with its use.
-activated charcoal / odor-absorbing dressings. These dressings should be changed daily or more often if the odor becomes noticeable before the next dressing change is due.
-Peppermint oil - many pharmacies carry this oil. You can place gauze in the top with the lid off and it works as an air deodorizer. Peppermint oil is a much more tolerable air freshener than most air deodorizers. Do NOT apply peppermint oil directly to the wound. You can also apply peppermint oil to a wash cloth and drape over a fan or air conditioning vent. Peppermint oil should not be used alone, as it may become associated with the smell of the wound and lose effectiveness.
-Palliative radiation is another option and may help to heal the wound.

Although this post focuses on odor, always remember to treat the pain associated with any wounds.

See Prodigy Guidance for additional information on malodorous wounds.

Wednesday, March 29, 2006

Origins with Death

Since my breakup, I have moved into a new apartment. As I was unpacking my belongings, I came across some old books that I'd been shuttling around with me since high school. One of them was "Wipe Your Face, You Just Swallowed My Soul" by Hugh Prather.

Hugh Prather had a large influence on me during my mid to late adolescence. Not that his writing is all about death. He mostly focuses on reminding us to live in the now. The following comes from his book "Notes to Myself."

"She may die before morning. But I have been with her for four years. Four years. There is no way I could feel cheated if I didn't have her for another day. I didn't deserve her for one minute, God knows.

"And I may die before morning.

"What I must do is die now. I must accept the justice of death and the injustice of life. I have lived a good life - longer than many, better than most. Tony died when he was twenty. I have had thirty-two years. I couldn't ask for another day. What did I do to deserve birth? It was a gift. I am me - that is a miracle. I had no right to a single minute. Some are given a single hour. And yet, I have had thirty-two years.

"Few can choose when they will die. I choose to accept death now. As of this moment, I give up my "right" to live. And I give up my "right" to her life.

"But it's morning. I have been given another day. Another day to hear and read and smell and walk and love and glory. I am alive for another day.

"I think of those who aren't."

Tuesday, March 28, 2006

Your Truth: "I Want to Call My Wife." Part 2

Your differing answers to this dilemma suggest that there isn't one right answer, but I will offer my thoughts and experience.

Death is an expected outcome in hospice and palliative care, therefore lawsuits over unrightful death are unlikely. However, I believe that the media's attention to the need for apologies in the light of medical malpractice may be extended to "mistakes" such as the one described in my previous post.

The Lancet recently published some data from research being done on the disclosure of medical errors:

"...patients were asked what they would have wanted to hear at the time of an incident. What they described was wanting to learn what happened, that someone would accept responsibility, that steps were being taken to prevent future similar incidents, and they wanted an apology."

Having heard that and having a personal policy of being honest and open, I decided to tell this patient's wife the truth.

When she arrived to the patient's bedside, I sat down beside her. I said, "I was there when your husband died. I want you to know that it was a very peaceful death."

I then continued, "I also want to tell you that last night, your husband asked the night nurse if he could call you. He seemed confused. The nurse explained to him that it was 2am and assured him we'd call you in the morning. He was doing so well yesterday, we were not expecting him to die so soon..."

I put my hand to my heart and tears filled my eyes (I was very sincerely distressed by this course of events).

I continued, "And it breaks my heart that we didn't call you. I'm so sorry."

The apology was sincere and heart-felt. Did this leave her anxiously wondering what her husband had wanted to say? Or did it offer her some comfort that he was thinking of her in his last hours? I can't say.

But in my heart, this disclosure felt like the right decision. She did not express any anger; instead, she seemed relaxed and comforted by my honest admission of our fault.

Friday, March 24, 2006

Your Truth: "I Want to Call My Wife."

Today I'm bringing back my old feature - the "Your Truth" series. For those of you new to my site... In this post, I will describe a scenario and ask how you would proceed.

Mr. Jameson is an 89 year-old man with congestive heart failure. He is on your palliative care unit or in your hospice for end-of-life care.

You are the day nurse coming onto shift. The night nurse tells you that during her shift, Mr. Jameson had woken up at 2am, asking to call his wife. She tells you that she had explained to him that it was the middle of the night and that he could call in the morning. She asks you to help him make the call this morning.

After report, you go to Mr. Jameson's room. You discover he is actively dying, and in fact within minutes of death. You use the phone at the bedside to call his wife, but she doesn't answer, because she is probably on her way to the hospital for her regular morning visit. You stay at the bedside with Mr. Jameson for the next few minutes and are present with him as he dies.

You find a colleague to process what has just happened. She asks, "Are you going to tell his wife that he wanted to call but that we didn't help him to make that phone call?"

What do you tell your colleague and what do you do?

As usual, please share your thoughts and then I will share what I have done in a similar circumstance.

See part 2.

Wednesday, March 22, 2006

Back in the Blogger Saddle

As the old adage suggests, it's time to get back in the saddle - with this site and with my schoolwork. Today, I am sitting in the library, working on my Master's Thesis, which is on - yes - death rattle. It's funny. I've been researching this topic since I wrote that old posting and I'm almost embarassed by how little I knew back then. The professor who is helping me with my dissertation is encouraging me to get my writing published in a nursing journal when I am finished and wants me to stay on for my PhD as there is huge gap in research on this topic. I would love to get the writing published, though I'll have to think long and hard about the PhD. I've been in school at least part-time for 8 years (well, with one year off in the middle somewhere). But I am so very ready for a break. And after that? Well, I may just be done with school for the time being. We'll see.

Most of my research until yesterday had been done on-line. (Medline has been a god-send). The few hard-copy books or articles I'd read had all been handed to me by mentors. So it's kind of novel and fun to sit in a library. There is something almost romantic about wandering down the aisles of books, flipping through their dusty pages, sitting at a public desk - free from all of the clutter and computer gear on my desk at home. But of course, there is also some discomfort - in the unfamiliarity of this environ and from my dust allergy! So I have retreated to the more familiar confines of the computer lab for the past hour.

Thank you all so very much for your kind words in light of my most recent loss - my divorce, that is. You all are the best! I have so very much appreciated the comments and emails. And thanks for coming back, even with the long periods of silence.

I'm hoping writing my master's thesis will not monopolize my time too much and that I will be able to write more frequently than I have been writing. I will graduate at the beginning of June (God willing - that I finish my thesis so I can graduate) and after that, I will have significantly more time for posting.

Best wishes to you all!

Saturday, March 11, 2006


I'm sorry for the silence.

Twenty-eight days ago, my partner and I split up. This is essentially a divorce, given the fact that we have lived together for over nine years, our bank and credit card accounts are all joint, she's on my health insurance plan, and we're registered as domestic partners.

That said... I've hesitated to write about this on this blog. Partly, it is honestly out of a resistance to sharing more of my grief in this space. This blog was developed to explore my personal and professional experiences with death and dying. And while, yes, that includes grief, this past year has provided me with more than my share of grief. First my grandmother died a year ago this past week; my aunt died shortly thereafter; then my grandmother's cat died recently and now I'm in the midst of a divorce.

Surprisingly, I am still standing tall despite the abundance of loss in my life.

But I feared weighing this blog down with yet more tales of my personal losses.

I have been rather anxious to refocus this space on my academic growth pertaining to the end-of-life process. But alas, life has other plans in store for me. :-)

Meanwhile, since I'm on the subject of grief, I thought I would share a link my dear friend Jenny emailed to me. This is for a Grief Retreat in Las Alpujarras, Andalucia, Spain. I will be taking a course on grief starting in April - it will be my final elective as I finish up my Master's degree. Though I have to say - a retreat in Spain carries a little more appeal than the lecture-based class I'll be attending in the States. ;-) But in case any of you are interested...

Sunday, February 05, 2006

"You've Passed" by Neutral Milk Hotel

The lady is dying
She bends back like a wave
As her spirit is climbing
Through the hospital wall and away

And I wanted to hold you
As you made your escape
But now I should have told you
When your eyes were alive and awake

Always in life we all must make this mistake
And so I go it alone
And the pressure is great
I hold on to my own
Oh please oh don't go away

I wanted to know you
Before you started to fade
But I gave everything to
A lie and a farce and a fake

This song provides me some solace in my grief over my grandmother's death. I had wanted to be with her when she died, but my denial robbed me of that experience. I was, however, able to hold her cat as her cat died and found great comfort in that experience. And unlike the regret of this song, I was lucky to get to know my grandmother fairly well - through writing her biography with her - before she died.

Wednesday, February 01, 2006

Guest Speaker: Alicia

I have entertained the idea of "guest speakers" on this blog for awhile now. I've received some truly beautiful stories via email and finally someone agreed to let me post their story. The following post was written by Alicia:


One of those things, working on my floor, every now and then we have a death of a patient that really affects us.

I was surprised when I came on yesterday morning that my patient, Ms. Russell hadn't died already during the night. She had had a couple of anxiety episodes during the night where she had flailed her arms. My co-worker Margie apparently had been in her room almost every half hour during the night, although for the most part it sounded like the patient had had a good night. I think Ms. Russell affected me so much because she was so young, with such a preventable cancer, such a devoted family, such a young son (he was a freshman in college) and she was obviously very well loved, affected everyone. Shoot, half the time the patients we have are geriatric patients with pneumonia who are surrounded with their families, but that is easier for me because I somehow feel that that is more the course of life. They have lived to see their family members grow up and die surrounded by them.

Ms. Russell's family was so anxious, and I worked so hard with them to assure them that we were making her comfortable, explaining everything that was going on, making sure all the Palliative Care docs went in to see them. Yesterday her whole family was still there, and I took on the "to turn or not to turn" debate with one of her doctors as Ms. Russell had a stage 2 on her sacrum, but turning made her so agitated. I didn't turn her right before shift change the night before because the patient's son felt that she might actually be responding to him, and asked me not to turn her because in order to do so we had to premedicate her with ativan. She looked very comfortable and he felt like he might even see her nodding when he talked to her and he asked that I not "drug her up." Since she looked so comfortable, I didn't turn her, and didn't give her any medication. Her husband then followed me out, and said, "he is so desparate to get something from her, he is trying so hard to get some kind of response or validation from her, so thank you."

So yesterday when I came on, she looked very comfortable. She had one episode of arm flailing during the morning. Her husband asked me if I thought she would die if he went out for a couple hours. He wanted to be there when she died, so if I thought she might die, he wouldn't go. I told him we really couldn't know, her respirations were steady at 16-18, and she looked comfortable. Her doctor was there, and we both informed him it was very possible that she might die once he left (since patients somehow seem to wait until their family members leave to die.)

So finally at 12:20 yesterday afternoon, the husband said to the patient, "It's OK, we love you and you can go anytime you want to." The patient then began to shed some tears out of her closed eyes, and died.

He gave her the OK to move on, and she gave her husband and son the validation they were looking for.

Have you ever heard of an actively dying patient, unresponsive, to shed tears before they die?


What a beautiful story! Thanks so much, Alicia, for sharing this with us. No, I have never witnessed a patient crying moments before death nor heard a similar story. But this was very moving.

Has anyone else had similar experiences? Or would like to share a story of their own?

Sunday, January 29, 2006

Shakespeare Sonnet on Grief

In the tv show, Dead Like Me, there was a sonnet quoted:

No longer mourn for me when I am dead
Nay, if you read this line
Remember not the hand that writ it
For I love you so
That in your sweet thoughts
I'd be forgot
If thinking of me then should make you woe.

Curious as to whose sonnet this was, I, of course, googled it. Interestingly, I came upon this verse from Shakespeare's “Sonnets” LXXI:

No longer mourn for me when I am dead
Than you shall hear the surly sullen bell
Give warning to the world that I am fled
From this vile world, with vilest worms to dwell:
Nay, if you read this line , remember not
The hand that writ it; for I love you so,
That I in your sweet thoughts would be forgot,
If thinking on me then should make you woe.
O, if (I say) you look upon this verse,
When I perhaps compounded am with clay,
Do not so much as my poor name rehearse;
But let your love even with my live decay:
Lest the wise world should look into your moan,
And mock you with me after I am gone.

I had to laugh, reading the final line of the complete version...

There has been multiple delays in getting Orange Kitty's ashes back from the vet. Did I mention that next time I would handle transport to and from the crematorium on my own? ;-) Anyway... for reasons, I have not yet surmised, this delay has triggered a new bout of grief. I've been crying for Orange Kitty, as well as for my grandmother again. And I have been imagining my grandmother mocking me. She was not overtly sentimental nor demonstrative. So I keep imagining her impatience with my grief. That said, this is also the woman who saved her mother's journal and genuinely enjoyed writing her biography with me. So mock my tears, she may. Or she may not. Though at this point, it's of no concern to her really. These tears are not hers, they're mine.

Monday, January 23, 2006

Get Your Federal Hands Off My State Bill

In the Washington Post on 1/18/06, I heard that Justices Upheld Oregon's Physician-Assisted Suicide Law.

Of course, I was totally out of the loop and not aware that there was even a threat to this Oregon state legislation. So, of course, I have to share my two cents on this subject matter. Some of this content has appeared in prior post(s), but it seemed particularly pertinent in light of recent federal news...

In the U.S., our society reinforces the notion that each individual has a right to die. This philosophy is supported by the existence of measures such as durable power of attorneys, living wills, and advanced directives.

In this regard, passive physician-assisted suicide is already legal in the U.S. It is legal to hasten the death of a person by altering some form of support and letting nature take its course. For example:

-Removing life support equipment, turning off a respirator or
-Stopping medical procedures and medications or
-Stopping food and water or
-Not delivering CPR and allowing a person, whose heart has stopped, to die.

Who has the right to die?

As law now stands, when a competent patient with a terminal illness makes an informed decision to withdraw or refuse life-sustaining treatment, there is virtual unanimity in state law and in the medical profession that this wish should be respected.

Although patients can be hospitalized against their will on a 5150 for doing so, committing suicide or attempting to commit suicide is legal.

However, active physician-assisted suicide - whereby a doctor provides a prescription for a lethal dose of a medication that the patient may take to terminate their own life - is not legal in most states.

What does this mean for people whose illnesses will cause their health to decline excruciatingly slowly, causing prolonged suffering, possibly over a period of years? People who have no life-sustaining treatments to withhold?

One example I will use is a patient I had who had chronic obstructive pulmonary disease. At the point I met him, he reported that he was no longer able to engage in the activities that made life worthwhile for him due to the severity of his difficulty breathing. He admitted to me that he was contemplating suicide. Not having given much thought to physician-assisted suicide before, I followed the standard suicide protocol. I assessed that he did not have a plan in place. We made a contract that he would not try to kill himself while in the hospital, with the hopes that the treatments we provided would relieve his suffering enough that he might no longer wish to end his life. My approach made it clear that at that time, I did not believe that suicide was an acceptable option. Were the contract and the negotiation helpful or were they isolating him even further in his suffering? Might I personally want to die if I felt that I was slowly suffocating, breathing becoming more and more difficult over time?

Physician-assisted suicide has been legal in the state of Oregon for over seven years now. It has been legal in the Netherlands for over twenty years. It has been legal in Japan since 1962. It has been legal in Switzerland since 1941. It has been legal in Germany since the year 1751.

Why might People Choose Suicide?

Let’s take a look at the statistics in Oregon for some answers:

Is it because they are not aware of other options?
86% of patients who utilized physician-assisted suicide in Oregon over the past seven years were enrolled in hospice. In 2004, that percentage increased to 89%. Hospice is generally the best thing we have to offer people at the end of life. What other options are there?

Who is using physician assisted suicide? Is it the poor and disenfranchised, whom nay-sayers suggest doctors are wanting to "kill off"?

Of the 208 patents who have utilized PAS in Oregon, 98% were white; 99% had insurance. Oregonians with a baccalaureate degree or higher were 8.3 times more likely to use physician-assisted suicide than those without a high school diploma.

What diseases are these people dying from?

Patients with ALS are by far the most likely to utilize physician assisted suicide. The life expectancy with ALS is 2 to 5 years. During these two to five years, slowly progressing paralysis and muscle wasting occur. These patients frequently die when they are paralyzed throughout their entire body and then finally their respiratory muscles become paralyzed and they can no longer breathe. I cannot imagine wishing such a torturous death on anyone!

My aunt had ALS. She had saved all of her prescription pills for many years before her diagnosis, perhaps having some premonition of what would come. Her diagnosis with ALS came after she went to the doctor because she was unable to swallow. Unfortunately, her first symptom, took away the only option she saw for herself. Instead of being able to end her life before becoming debilitated, as she had planned, she rode out the following three years until she was able to move nothing more than her eyes. If she had the option to kill herself, her sister believes that she would have. And I would have supported her in making that decision.

Suicide has been decriminalized for many decades in most jurisdictions in North America. So why make it unavailable to those who need our compassion the most?

Physician Assisted Suicide is about:
1. Respect for autonomy
2. Justice
3. Compassion for suffering
4. Individual liberty
5. Openness of discussion: Assisted death already occurs, albeit in secret. Keeping it illegal prevents open discussion between patients and physicians.

Legalization of PAS would promote open discussion. It would assure dying patients that they would not be put in a hospital on a 5150 for saying they’re contemplating suicide.

Although much of the opposition to physician assisted suicide has come from religious organizations, some religions have issued statements in support of physician assisted suicide including:

• The Unitarian-Universalist Association
• the United Church of Christ,
• the Methodist Church on the US West coast
• The "Episcopalian (Anglican) Unitarian
• The Presbyterian church
• and the Quakers

Legalizing physican-assisted suicide does not take away one's right to choose to live out their life throughout the disease process, it simply provides another option for those who would choose to forgoe further suffering.


Friday, January 13, 2006

Music Thanatology

Thanatos is the Greek word for death. A music thanatologist is someone who specializes in creating a music therapy prescription as part of the dying experience - both for the patient and the family.

At some points in your life, I am sure you have noticed physiological responses in yourself that have related to music. Personally, my choice in music varies depending upon whether I am excited, sad, or angry. And music can help to either shift my mood or to enhance it. At the end of life, we continue to have physiological responses to song.

In the United States, music vigils at the end-of-life frequently consist of harpists. Live harpists can adjust the music tempo to the rhythm of the patient's breath.

Many other cultures also have musical traditions that pertain to the end of life.

The traditional Hindu song "Praan Tanse Nikle" is a musical prayer to Lord Krishna, seeking liberation at the time of death.

In Chinese Buddhist culture, the chanting of sutras and mantras may be accompanied by musical instruments. The most commonly recited sutras are Amitabha Sutra, the Heart Sutra, the Diamond Sutra, and the Earth Treasure Sutra. In my work setting, the same Chinese Buddhist chant has been used with multiple families. It's very beautiful, though I haven't figured out which one I've been hearing yet.

For some patients, we play general instrumental, relaxation or meditation tapes. We have had some patients or family members who have brought in their own music, which included songs that they liked from pretty much any genre out there.

Since Orange Kitty's death, I have been craving songs about grief and loss and death. They aren't so easy to find! [Let me know if you have any suggestions].

One song I've run into, "If I Could" by Jack Johnson, contains this great line:

"I heard some words from a friend on the phone, didn't sound so good. The doctor gave him two weeks to live. I'd give him more, if I could. You know that I would now. If only I could."

When I hear that song, I am reminded that... Although I had Orange Kitty put to sleep, if I had been able to give her back her comfort and her function, I would have wished her an even longer life.

The song "Bowl of Oranges" by Bright Eyes has a line that really speaks to me. When I'm sad that we can't cure someone physiologically (one of my patients at work), this song reminds me of what I can do:

"I came upon a doctor, who appeared in quite poor health. I said, 'There is nothing that I can do for you you can't do for yourself.' He said, 'Oh yes, you can, just hold my hand. I think that that would help.' So I sat with him awhile, then I asked him how he felt. He said, 'I think I'm cured. Well, in fact, I'm sure. Thank you, stranger, for your therapeutic smile."

Although I don't expect a physiological cure from holding someone's hand and smiling, I am reminded time and again of what a profound effect these simple gestures can have.

Okay, I went off on a bit of a tangent there. Back to music... What kind of music or what songs would you want to hear at the end of your life?

For more information, Growthhouse Radio has a large selection of music that may be used as part of a musical vigil for someone who is dying.

Thursday, January 12, 2006

Orange Kitty's Final Hour

On Tuesday, at about 11:45am, Orange Kitty breathed her last breath.

Euthanasia wasn't exactly what I expected. I'd never put a pet to sleep before. This was a learning lesson. I would do things just a little bit different next time.

The vet came to our house. The poor man! To walk into someone's home and cause so many tears with your presence!

He gave Orange Kitty an injection to sedate her before the lethal injection. She hated it! It was an intramuscular injection in her left thigh. She turned and hissed at me and bared her claws at me as it was done. She'd never hissed at me before! Not even with all of the fluids I'd given her through a needle. I felt so bad that it hurt her so!

She then stood up and repositioned herself. And she layed down so naturally, but then her head got heavier and heavier.

Then she started vomiting as a side effect of the sedative! The vet clearly felt bad and apologized multiple times, saying that didn't happen very often. Orange Kitty had had stomach problems, so I didn't begrudge him that, though I was anxious for her to feel better.

The vet then shaved off some fur from her front left paw to find a vein. He asked if we had any final words to say to her. My mind went blank.

The lethal injection didn't work as quickly as I'd anticipated it would. She breathed several very infrequent but deep breaths for about two more minutes after. The vet turned his back on us after looking for a blink reflex and listening to her heart and said, "Well, I have to bag her now."

She was still having a few of those deep breaths! I said, pathetically / inassertively through my tears, "Can we wait until she stops breathing?" I felt panicked. He wants to bag my cat before she is fully dead!

The home vet had asked if we wanted to take her to the crematorium ourselves or if we wanted him to cremate her for us. I asked if he would take her, since we don't have a car. But then I realized afterwards that he needed to rush to his next appointment. Next time (we do have two more cats and a dog whom we'll likely outlive), I would take our pet to the crematorium ourselves, so we could spend as much time with him/her as we want.

I still feel good about the experience. He waited for her to stop breathing, per my request. And he left us a condolance card with a phone number for a 24-hour grief hotline. The only thing I'd do different next time is that I would take her to the crematorium ourselves.

It was very loving to get to hold her as she died, despite how sad I was to hand her limp body over to the vet.

The rest of the day, her body having left my presence prematurely, I wrapped myself in the blanket she died in and wore it around the apartment for the next few hours, just to feel close to her.

I made a crayon drawing of her as an angel (crayon, because I didn't want my ego invested in how the picture would come out, since it was meant to be therapeutic and not a source of frustration). And I lit a candle in her honor before going to bed.

The house has felt empty and quiet since she died. I wake up every morning with an ache in my heart, knowing she's gone.

But I feel that she is at peace and I have prayed that she knows that I loved her.

Monday, January 09, 2006

Grandma's Kitty

I have an appointment scheduled for tomorrow morning at 11:15am to have my cat euthanized. This cat was my grandmother's cat - the grandmother who died last March. The grandmother whom was obsessed with animals.

Orange Kitty (that's what my grandmother named her) is now 22 years old. She has been in renal failure for the past nine months. We'd been managing the renal failure fairly well up until the last ten days or so. I've been giving her fluids (lactated ringers to be specific for medical folk) with a needle under her skin ("subcutaneously" for medical folk). We started doing this every other day last April, but increased it to nearly daily for the past two months or so).

This has been a very difficult decision for me. It's so different being on the other side of this decision making. Orange Kitty used to respond so well to the fluids. I made jokes that it was kind of like watering her like a lawn. Shortly after the fluids would go in, her fur would look much healthier. She would also bounce around like a kitten. The fluids worked better than cat nip for her energy level.

But then the past ten days, she has had trouble walking. She has fallen numerous times. I am always so frightened after she has fallen, that she may have hurt herself. She seems stiffer and readjusts her position in a way that suggests she may be in pain. We've given her a hot pad to lay on and that seems to help some. But now she can no longer walk very far and has been urinating on herself. Cats are so obsessive about cleanliness; I can't imagine she is happy all covered in urine. No matter what I use to clean her, she still smells of cat pee. She hasn't been eating anything substantial for ten days now. I've enticed her to a paper-thin fish flake every now and then, but that's it. The last time she ate anything more substantial, she began vomiting continuously.

A part of me thinks I have waited too long - that she has been suffering for too long and that is inhumane. Another part of me thinks I should wait until she dies naturally. I had no idea how difficult this decision would be. I wish I had a "palliative care" option for Orange Kitty. I wish we could get her symptoms under enough control that I felt comfortable letting her die naturally.

I am sad that Orange Kitty's death is inevitable.

I am afraid Orange Kitty's death might trigger more grief over the loss of my grandmother last year.

I blame myself for Orange Kitty's death, even though I know it was inevitable (the cat is 22 years old!)

I am mad at myself for adopting Orange Kitty when my grandmother died, because now I am having to grieve again.

I feel guilty for feeling a sense of relief in Orange Kitty's impending death - the relief from the waiting and the relief from the emotional difficulties I had giving her the fluids. (She hated getting the fluids and cried out every time I did it, so I felt like I was torturing her. I could never be a vet).

I am worried that my friends will run from me, because I am grieving yet AGAIN.

I worry that I am not grieving the "right way" and this will draw attention to my deficits as a palliative care nurse.

I am frustrated that I am not stronger and thus am not grieving more gracefully - again a fear that people will run from the awkwardness of my grief.

I am relieved that I have an appointment scheduled to have Orange Kitty euthanized at home. I have been making phone calls for 5 days now to 4 different vets trying to arrange for a home euthanasia.

I'm sad that Orange Kitty didn't die naturally - before she got to the point I felt it was inhumane to keep her alive.

I have mixed feelings about the fact that Orange Kitty is having a good day today. I'm relieved for her happiness, but frustrated for myself as I now question my decision of scheduling the euthanasia.

I am frustrated that I have to lay a blanket on my lap before holding Orange Kitty, otherwise all of my clothes wreak of cat pee. It feels like an emotional barrier as well as a physical one.

I am angry that my Mom accused me of being inhumane when I told her Orange Kitty was dying. She said I should have put her to sleep a long time ago. I am resentful that my Mom didn't offer sympathy and support instead, which is what I needed.

I am relieved that I have had the opportunity to lovingly hold Orange Kitty in my lap, despite the blanket between us, and to give her affection in her last days.

I feel guilty because I'm writing this post, instead of just sitting and being present with my cat who is dying.

I am sad that I must say goodbye to Orange Kitty, who has been so affectionate and charming, the confident queen bee of the house, even in her frail years. I will miss her warmth in my lap, her soft fur under my fingers, her enthusiasm for treats, the annoying way she sucked at my earlobes and licked my face, the unique way she moved with her double-jointed legs, how passively she argued with me about her fluids - making lots of noise but minimal wrestling, and her cute but scruffy face marked with two small growths from her renal disease. And I will miss her because she was my grandmother's cat - a physical being whom I could hold and love as a reminder of my dear Bobby.

May Orange Kitty feel well-loved during these last 22 hours of her life and may her spirit be reunited with Bobby's.

Friday, January 06, 2006

TV Review: Dead Like Me pilot

I was cruising around my local video store, looking for something entertaining to keep me up the night before my most recent night shift, when I came across the DVD cover for Dead Like Me. Of course, any movie with a reference to death in the title generally attracts my attention.

Dead Like Me is a tv series on Showtime. Not having cable myself, I'd never heard of it before.

The plot is that this young woman named George dies in a freak accident and is then recruited to become a grim reaper. George had dropped out of college, was living with her parents, had no job skills to market and seemed generally miserable before she died.

I was not expecting much of this DVD. The premise sounded a little over-the-top. And it is! But that is what was so great about it!

George goes through on-the-job training to become a grim reaper. Grim reapers are given a last name and first initial of the person whose soul they're going to collect and the date, time and location of the death. Their job is to figure out who is going to die. If they're going to die in a painful accident, their goal is to take their soul before "impact."

The deaths in the pilot were mostly pretty ludicrous - one woman had a piano dropped on her and one man died after slipping on a banana peel. Despite the quirkiness or perhaps because of it, I found it refreshing to enjoy the silliness of this show's portrayal of death. Life needn't be so serious all the time. :-)

There were some little inconsistencies in the storyline that were a little off-putting. For instance, they're suppose to take the souls before they're dead. But when the woman was killed by the piano falling on her, the grim reaper waited until after the piano fell before taking her soul.

In addition, George tries to prevent the death of the person whose soul she is suppose to collect. (Sorry if I'm ruining the plot of the pilot for those of you who haven't seen it). Instead of somehow demonstrating why that doesn't work, the boss simply tells George that the souls will die inside the people. And that explanation somehow seemed kind of like a bandaid over a crack in the plot. Of course, I have only seen the pilot, so perhaps that way of handling the crack was a way to leave it open for use in a future episode.

That said, my favorite line from the pilot is one of the other things George's boss tells her after she tried to intervene in the death:

"You can't save any of them. All you can ever hope to do is make it easier. And that may not seem like a lot, but it is."

I couldn't agree more.

Tuesday, January 03, 2006

Spiritual Beings Having a Human Experience

During dinner with a dear friend last night, I had been talking about how I was struggling to "find my spirituality." My friend told me, "You don't have to search so hard...

"We are not human beings having a spiritual experience. We are spiritual beings having a human experience."

That quote was so perfect in the context of our conversation. I loved the line and wrote it down immediately. When I asked her whose words they were, she didn't know.

When I googled this quote, I was amused by the various different people whom have been given credit for these wise words. One site attributed this quote to someone named Sant Rajinder Singh. Another site gives credit to Ram Dass. Yet another site attributes this quote to someone named Jackie Small. The majority of sites give credit to a French theologian named Pierre Teilhard de Chardin. But who knows. I think it's a great quote, nonetheless.