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...