Sunday, November 30, 2014

Facilitating a Good Death for Your Loved One

Dedicated to my friend, Amelia Pryor, who passed away October 17, 2014.

Who has not wondered, at least once in a while, what their last moments will be—fraught with agony, grief and remorse, or eased with peace, acceptance and joy. Concern about a loved one's passing can weigh especially heavily on a caregiver who feels such deep responsibility.

So, how can caregivers help to facilitate a “good death” for their loved one while taking care of themselves? Although never easy, preparing for the inevitable is the first step.

In our own time, death has been denied, rejected or treated as an abject failure.  Other cultures take an opposite view. Some have had an obsession with death, or death may be treated as an ordinary, everyday reality, or as the highest reward. Consider ancient Egypt and the cult of the dead: royal mummies placed in outsized pyramids rise out of the desert sand. Or regard contemporary Catholic Mexico with its All-Soul’s Day, children dangling skeletons and other remembrances of our human mortality. Even today, death haunts certain sectors of the Arab world, whose belief in jihad (death to non-believers) attracts young, displaced men, who do battle to die for their cause, and win a special place in Paradise.

When Americans do reflect on death (which for most of us is a special, even rare occasion), a good death may mean having one’s loved ones in attendance or at least having said a loving goodbye, and, above all, enjoying a painless passing. But the reality of our current snarl of medical, drug and insurance interests has confounded these simple goals. For many, dying has turned into a prolonged period of extreme medical interventions and a final, agonizing and only-too-often anonymous demise in a hospital or nursing home.

Caregivers can do better for their loved ones. Consider some of the following suggestions for easing the end of life.

1. Plan Ahead. The capstone of a life well lived requires talking about it beforehand. Even if that conversation never occurred, do the right thing by considering what your loved one would have preferred if they had had a voice.

2. Contact Hospice.  If your patient has a life-limiting disease, hospice treatment, with its focus on care, not cure, can address the full range of physical, emotional and spiritual needs of a dying person.

3. Make Your Wishes Clear. While you’re at it, why not also have a say in your own end-of-life care by completing an advance directive? Having that talk about your own mortality and how you choose to end your days can be a tremendous relief for both you and your family. Your fears and denial about your own ending will be profoundly lessened.

4. You Have the Power. As a caregiver, you can be an advocate for your loved one by having a Medical Power of Attorney. Strive to create the perfect setting for his or her final moments, whether in a care facility, hospice residence or your own home. Your dying loved one may enjoy special music or a religious ritual and the awareness that their nearest and dearest will continue to remember and honor his or her life.

5. Develop a No-Regrets Perspective. By providing the best care possible over the course of the illness, and by staying within your own physical, emotional and financial limits, you can free yourself from guilt and distress as you let go of your loved one. Being at peace with yourself will ultimately make for a more peaceful passing for your cherished person.

Tuesday, November 4, 2014

Plan of Action in the Event of a Crisis

It may be instructive for some readers to know that I landed in my local hospital (PeaceHealth St. Joseph Medical Center in Bellingham, Washington) over the summer with a compressed back fracture after a fall in my garage. I managed to avoid surgery, but the healing process has been excruciating, and ever so slow. I did manage to learn some important facts along the way, which I can pass along to you. 

1. Always be or have a strong advocate when you go through the emergency room—a typical route for accident, cardiac, burn or stroke victims.

2. Be prepared for different types of pain and discomfort. First is the pain of the original event or injury. Next, is the pain associated with medical intervention. Often that is surgery, but sometimes, other treatments cause ancillary pain. An important source of imbalance is pain medication, essential to endure the injury or medical situation.

However, over time, pain medication can produce constipation, anxiety, personality changes, agitation and other side effects, depending on the individual’s overall health and body chemistry. Another issue in the healing process is incapacitation: the inability to carry out your normal activities. In some cases, this can last for weeks at a time.

3. Be certain you or your advocate has a grasp of hospital organization, can be present for discharge and fully understands the physician’s instructions. This includes types of medicine, times to administer, dosages and warnings of potential interactions. Medical staff should also discuss the physical limitations of the patient, next doctor’s appointment, short-term home care and long-term prognosis. 

Preferably, have a second person on board who can verify the doctors’ orders—a close relative, friend or professional caregiver hired before you or your loved one come home.

If the patient has been formally admitted and spent at least three nights in the hospital, he or she may qualify for rehabilitation services. Ideally, the caregiver has already researched available facilities. If not, it’s wise to do so before release. 

Remember: Planning for a possible crisis before it happens can assist you, your loved one and your entire family to achieve a smooth transition into care—and back to wellness.