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.
Thursday, June 29, 2006
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.
---
O.K.
---
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.'
---
Unexpectedly.
---
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'...love that
term....calm abiding....not easy....such a worthwhile,
beautiful practice....so, 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
but
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
me.
---
"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.
---
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.
---
O.K.
---
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.'
---
Unexpectedly.
---
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'...love that
term....calm abiding....not easy....such a worthwhile,
beautiful practice....so, 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
but
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
me.
---
"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.
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?
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.
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."
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.
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.
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