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Thread: A Good Death

  1. #1
    TJ TeresaJ's Avatar
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    A Good Death

    Dying is something that we talk a lot about in nursing school. We stress patient autonomy, providing comfort, and how nurses are in a position to initiate conversations about death. The general consensus is that western medicine has made "living easier and dying harder." The way that people are living and dying has changed in the past generation. Old people are increasingly likely to die of organ failure and frailty than of sudden death or a terminal illness. We're taught that dying in the ICU, undergoing many interventions, is a stressful way to go. Our professors promote hospice as being a particularly comfortable, dignified, respectful way to die.

    I know that many of you have experienced the death of loved ones and probably feel differently. If you care to respond, I'm curious to know:

    - Does the description above seem accurate? If not, how so?

    - What kind of conversations did you have with your family about the dying process?

    - What do you wish had gone differently?

    - Do you think about your own death, and if so, realizing that it's a possibility that you will live to extreme old age, what would you like to happen, medically, as you approach death?
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

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    TJ TeresaJ's Avatar
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    Article that takes an anthropological as well as a nursing perspective. : Concept Analysis of Good Death in Terminally Ill Patients
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

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    Senior Member Sinny's Avatar
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    As some of you may have already read, I recently joined the care sector, and I'm currently working in a residential care home.

    I had to laugh the other day (in a macabre sort of way) when I was on shift.. It was a little before lunch when I approached one of our residents who was being visited by her daughter.

    The elderly lady in question is 90 something, her daughter perhaps 60 something... Mom's suffering worsening dementia, and frailty. Daughter is caring, astute and well versed in societal matters.

    I came over to introduce myself, and to just have a chat.. we discussed mom's life before the dementia, her deterioration, and her rabid decline inside the residential home environment, - which promotes and yet inadvertently restricts individual liberty.. and the daughter made a point that in these care settings people aren't "allowed" to have accidents, instead we proverbially keep them wrapped up in cotton wool, extending their lives indefinitely, no matter their quality of life...

    The way she said it was from a view of detached pragmatism.. A lot of these people in their 90's all have children in there 60's or so.. this is pleasant for the small minority living with their faculties, but for so many others it is .. burdensome. It does feel unnatural in a way, in the instances where some feel that nature should have taken it course by now.
    Last edited by Sinny; 05-23-2017 at 08:20 PM.
    "One need not destroy one's enemy. One need only destroy his willingness to engage"

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    Senior Member Starjots's Avatar
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    My grandma had cancer and my older sister arranged for hospice. I don't believe they told her she had cancer. She died at her home and as these things go it was probably as good as it could have been for everyone. Dying was a process.

    My Mom also got cancer which was pretty much a death sentence. My Dad was pretty weak by that time and she went to the hospital. Hospice wasn't used. The doctor tried a heroic and difficult procedure. Last memory of her awake was being wheeled off to the operation giving the thumbs up. That was her in spades. It didn't really help and she passed several weeks later - I don't believe they tried any other heroic measures.

    My Dad decided to stay on his own after that although we tried to get him to live with us. One of us siblings found him less than a year later at home, his ticker had given out at last. This seems pretty terrible, but all concerned agreed this was what he wanted. It was also him in spades.

    We've told our kids we plan on staying active as long as possible and have long term care insurance if it gets to that. Personally I'd like to be at home when the time comes if it's that sort of situation. I fully agree people should have a lot of choice in how and when they die. This is an issue where I think current medical practice has kept up with the times.

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    Senior Member Senseye's Avatar
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    Quote Originally Posted by Starjots View Post
    This is an issue where I think current medical practice has kept up with the times.
    Really? If so, I would say just barely.

    I'm Canadian and we just recently legalized doctor assisted suicide and it's still very controversial. The courts had to get involved because politicians were too cowardly to legalize it on their own. Religious kookiness still permeates a broad swath of society.

    Google tells me only 6 states in the US have legalized it. I would accuse medical practice of dropping the ball severely on this very important option (although it may not be the medical professions direct fault). Should have been legal at least 20 years ago IMO.

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    TJ TeresaJ's Avatar
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    Quote Originally Posted by Senseye View Post
    Really? If so, I would say just barely.

    I'm Canadian and we just recently legalized doctor assisted suicide and it's still very controversial. The courts had to get involved because politicians were too cowardly to legalize it on their own. Religious kookiness still permeates a broad swath of society.

    Google tells me only 6 states in the US have legalized it. I would accuse medical practice of dropping the ball severely on this very important option (although it may not be the medical professions direct fault). Should have been legal at least 20 years ago IMO.
    It's legal in Oregon but less than 1% of the people who have the option use it.

    It's a distraction from the main issue, which is quality of dying. Quality of life up to the time of death.
    Too bad, Lady Une. You were far too lenient.
    As a soldier, yes. But as a civilian I lived an austere life.

  7. #7
    malarkey oxyjen's Avatar
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    I have no idea of any of that is accurate. So far I've not had to experience the death of any close family or friends. I do wonder if it were my spouse, that perhaps I would be in such denial of the fact they were dying that accepting them going to hospice would be akin to "giving up." I have no clue though, as I've never been in that situation.

    Also muddying the waters is that the more experience I have with doctors and treatment of illness, the more I realize that the medical profession is making their best guess with their prediction of outcome, but they speak in generalities and statistics. How your one individual loved one will react to treatment? Really no clue unless you try. A close family member was diagnosed with stage 4 cancer, metastasized to multiple organ systems. She was given less than a month to live without treatment, and up to half a year with treatment. She decided to accept treatment due to her family's urging (she had been through cancer treatment before and loathed it), yet we still did end-of-life planning with her. She received the diagnosis four years ago. The treatment ended up reducing the cancer so it's now not even perceptible on her scans. It's crazy to think that she was flirting with the idea of not receiving treatment because they estimated her life to end quickly no matter what. The doctors encouraged her to get treatment, however.

    She was that one in a million case, the winning lottery ticket. Probably everyone wants their family to be the person that has the winning lottery ticket. Although someone feeling relatively fine and getting a terminal diagnosis unexpectedly is very different than someone who has undergone several interventions and is residing in the hospital, depending on treatments. Thank God my parents have finished writing up their thorough medical directive with their attorney so my sister and I can refer to their explicit wishes, rather than make the judgment call for them. They are ok with dying and in most circumstances don't want interventions to prolong their life.
    Last edited by oxyjen; 05-25-2017 at 08:55 PM.

  8. #8
    Quote Originally Posted by TeresaJ View Post
    I know that many of you have experienced the death of loved ones and probably feel differently. If you care to respond, I'm curious to know:

    - Does the description above seem accurate? If not, how so?

    - What kind of conversations did you have with your family about the dying process?

    - What do you wish had gone differently?

    - Do you think about your own death, and if so, realizing that it's a possibility that you will live to extreme old age, what would you like to happen, medically, as you approach death?
    The family signed papers to have my grandma pulled from the hospital. She was suffering from dementia, and the unfamiliar hospital setting was a nightmare for her. My brother and I took turns keeping her company until she went. She was far happier and lucid at home. Her happiest day in months was the day she died. Her memory was at 90%, she smiled and laughed and talked about the good days. She also reminded everyone that it was her time and she was ready to go. Very dignified.

    The actual death, not so much. I won't describe it other than to say if I would've had a button to insta-kill her with, I would have used it. My brother has actually been conflicted since that night with guilt that one of us didn't get a gun out and end it at an earlier point than nature chose.
    Quote Originally Posted by whatloveihave View Post
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    Scobblelotcher Sistamatic's Avatar
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    Yeah, Grandma's death was not pretty. I'm torn between relief that I wasn't there and wishing I could go back in time and shoulder the burden of having been there in lieu of my little brothers. It's an older sibling thing. Mostly I'm just glad she wasn't alone.

    I took my cat home from the vet after a sudden cancer diagnosis. He was fine that morning, that night he had trouble breathing, I took him to the emergency vet thinking they could fix whatever was wrong, but it was cancer and he was dying...like right then, he was dying. I thought I'd have a couple of days to say goodbye, but that night that he was home was hell for him. We had the in home euthanization come out first thing the next morning. I wanted him to live, but that wasn't in my array of choices. I could have continued having his collapsed lungs drained over and over so that he could breathe (unpleasant and painful) and I could have tried chemo in the meantime, and maybe tried to do something about his congestive heart failure, but the prognosis for him was that he was going to die, and my choices were to A)put him to sleep, or B) let him die (while on painkillers), or C)put him through pure hell until no amount of money or torture could keep him with me any longer, and then he'd die anyway.

    My point here is that if you are a human, you don't have option A, option B is typically frowned upon, and option C is the default.

    I know a high ranking medical executive and he feels as if option C became the default because insurance companies will pay for it and hospitals and drug companies can make a ton of money per day off of grandma lying there on a her deathbed for months on end. He told me that a disproportionate amount of the cost of insurance is due to the prevalence of option C, and that with baby boomers heading into that age bracket, option C might break the system completely. But he doesn't have much hope that our culture will allow A and B to become the norm.
    Insults are effective only where emotion is present. -- Spock, "Who Mourns for Adonais?" Stardate 3468.1.

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  10. #10
    TJ TeresaJ's Avatar
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    @Sistamatic

    At least in nursing school the professors are very aware of the costs (human and financial) associated with option c, which is why they're pushing option b (hospice). It will be interesting to see what it's like in the field. I start my geriatric clinicals next month.

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