Learning to Accept Death

Arti Allam, Medical Student, 12:27AM Dec 15, 2010

source :
http://boards.medscape.com/forums?128@55.ThQDaCJlGIG@.2a0556c3!comment=1

During our internal medicine rotation we have a palliative care day designated for us to learn about pain management, delivering bad news, and the options available with end of life care. We also were able to visit with patients in different hospice settings and members of the team caring for them in this critical period of life.

I had the opportunity to visit an 86 year old gentleman, Mr. H, who is receiving continuous hospice care in his home. He has battled prostate cancer for several years, and now that treatment options have run out, he and his family have chosen to keep him in the house he and his wife built together, where they raised three children, where they grew old together. The patient and his family have accepted that death is near; however it was interesting to see that they are not defeated. He was tired but still coherent, not talkative, but responsive, and he chimed in as we reflected on his life – his time in the military, where he toured the Philippines and Germany alongside his twin brother, his passion for agriculture, the awards he won in his community in Texas, notably, Dad of the year. We talked about his beautiful grandchildren and great-grandchildren, and he acknowledged that he was lucky to have lived such a fulfilled, meaningful life, surrounded by the love of family throughout life, and now in death. The only machine he was connected to was oxygen – no beeping, no IV’s, just warmth and home. He was propped in front of his flat screen TV (his old-fashioned TV now a TV stand) to watch his favorite football games – an avid Aggie dressed in maroon and white. His familiarity with his surroundings and the overall acceptance of impending death seemed to obliterate the factor of fear in this patient’s situation. After all, death is a part of life, and as human beings, maybe it is appropriate for us to accept that, especially in old age.

One thing that struck me was that the home hospice caregivers fit right into the home setting. The chaplain said a prayer with the family, and they included us in their circle joining hands with each other and with us. He was also able to provide the family with DNR/DNI paperwork, just in case someone was to call 911 when Mr. H stops breathing, but it did not seem like a harsh gesture, instead more a protective measure for the patient and his family. A continuous care nurse was there to help Mr. H’s children care for him, and I had to ask before I knew that she was not one of his daughters.

Being able to accept death when it comes close, dying surrounded by loved ones in our homes – I imagine this is what we all hope for, but why is it so rare that we can have this? Is it lack of education of healthcare personnel and the general public? Is it financial? Or is it that most of us don’t accept death early enough? I think all of these issues play a part – but of note, the chaplain told me that Medicare pays for 6 months of hospice, with no cost to the family. I personally did not know that home hospice exists and what it entails, so this experience was particularly enlightening for me. As physicians, through education and honesty about prognosis with ourselves and our patients, maybe we can help our patients die with less pain and more dignity.

regards, taniafdi ^_^