03/31/17

Soul midwifery – ‘Midwives’ of mercy

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The new breed of inspirational carers helping to ensure people’s dying days are spent in the comfort of their own homes

By Jane Feinmann

Colin Barber takes great comfort in the fact that his terminally ill wife, Valerie, was able to die peacefully in her own bed.

On Tuesday, September 1, 2015, ten days after she had been discharged from hospital, Valerie, who had bile duct cancer, took her last breath at home in their bedroom — ‘exactly as she had wanted, with her father and me on each side of her bed, gently holding her hands’, recalls Colin, 56, a business psychologist.

It was, he says, as serene a death as it could have been.

Yet it was nearly so very different. Instead of spending her last few days in peace at home, Valerie, like many patients, could have ended up being rushed to hospital and dying on an anonymous, noisy ward.

But she was one of the lucky ones: she was able to plan for her last days and ensure her wishes were adhered to, thanks to an award-winning new approach to end-of-life care known as soul midwifery.

The idea is that, just as a birth midwife helps to ease a baby’s entry into the world, a ‘soul midwife’ eases people’s dying days.

It is a cruel failure of modern medicine that while the vast majority of people — eight out of ten, according to the Office for National Statistics — want to die at home with their symptoms controlled and their loved ones around them, nearly half actually die in hospitals. Only one in five gets to die at home.

And just how ghastly dying in hospital can be was set out in a report by the British Medical Association published last March.

Based on interviews with more than 500 doctors and patients, it painted a grim picture of patients being given ‘entirely inappropriate invasive treatments’, and junior doctors often too fearful to provide adequate pain control.

Pressure on beds can mean dying patients are ‘shuffled between wards’, preventing continuity of care, while single rooms are prioritised for patients who pose an infection risk, so the dying rarely get privacy. The NHS failure to provide a dignified, peaceful death was highlighted this month by a study published in the BMJ’s Palliative and Supportive Care journal, which identified a postcode lottery in specialist palliative care.

As a result of this, patients are far more likely to be rushed to A&E at the end of their lives than to die pain-free, in peace, at home.

NURSES HAVE NO TIME TO CARE
The BMJ report followed a recent survey of almost 1,000 hospital nurses in which two thirds revealed they didn’t have enough time to care properly for dying patients.

Such is the concern that patients are being failed, that last week the National Institute for Health and Care Excellence (NICE) re-published guidance on end-of-life care first issued to doctors in 2015.

This restated four essentials: the need for doctors to draw up a care plan, provide individualised symptom control, monitor patients daily and ensure adequate hydration. Most people, says Professor Gillian Leng, deputy chief executive of NICE, receive good end-of-life care ‘but this isn’t always the case’.

End-of-life champion: Felicity Warner established soul midwifery in 2004

Good care involves asking people about their preferences as well as controlling pain, adds Sam Ahmedzai, a retired professor of palliative care who worked on the latest NICE guidance.

Yet a recent study showed that only one person in seven who could communicate their desires had those wishes documented.

This is far from a new problem. Ten years ago, a major report, the End of Life Care Strategy, featured an innovative plan to end the situation where ‘most people would prefer to die at home while only a minority manage to do so’, as then Health Secretary Alan Johnson put it.

Along with improved palliative care, the plan involved healthcare practitioners working harder to ‘identify people approaching the end of life and discuss with them their needs and preferences’.

DOCTORS CAGEY ABOUT THE TRUTH
Ten years on, although there has been a slight improvement (back then nearly six out of ten people were dying in hospital) there is still ‘a long way to go’, Claire Henry, chief executive of the National Council for Palliative Care, told Good Health this week.

So why is it still proving so difficult to get things right?

‘Some deaths happen suddenly, out of the blue, while with some patients it’s difficult to be sure whether they are dying or will recover,’ says Professor Ahmedzai.

‘That’s why we say that every patient in the last days of life should be monitored daily in case there have been changes and there is a chance of recovery.’

Research shows that, in fact, in four out of five cases GPs can predict which of their patients will die within the next 12 months. And three out of four deaths are anticipated by medical teams, according to NICE.

Professor Ahmedzai says: ‘We should be asking anyone admitted to hospital with a serious illness about their preferences for where and how they wish to die, should that look likely. But doctors often don’t because they are embarrassed or just too busy to handle that conversation. It can’t be an excuse. We must make time for the dying.’

Indeed, a major problem is that too often, dying patients simply are not told what their doctors know. Sometimes this is because doctors are unwilling to discharge patients so they can die at home because effectively ‘such a decision can be seen as an acceptance of failure’, the recent BMA report noted.

Research shows that in four out of five cases GPs can predict which of their patients will die within the next 12 months

Certainly, no one told Valerie or Colin that she was dying.

The banking relationship manager from Brentwood, Essex, had cancer diagnosed in 2013, two weeks after her 50th birthday, after noticing that the whites of her eyes were yellow.

Her GP referred her for an MRI scan, which revealed a large tumour wrapped around her bile duct.

She had surgery to remove part of her liver along with the gall bladder and bile duct, followed by three months of chemotherapy.

‘After the treatment we began to be optimistic that she was recovering,’ says Colin. But in October 2014 a scan identified nodules of cancer in the liver, too scattered to be removed surgically. In August 2015, Valerie took a sudden turn for the worse and had to be admitted to hospital.

‘We’d just come back from holiday, when she’d canoed 15 miles down the River Severn,’ recalls Colin. ‘Then one day she woke up so weak she could barely stand.’

Even so, ‘it didn’t occur to me that she was gravely ill,’ he recalls. ‘No one at the hospital mentioned the word ‘dying’.’

Valerie’s discharge from hospital three days later depended only on a physiotherapist checking that she could walk upstairs, which the couple took to mean she was on the mend.

‘But looking back on it, her doctors must have been aware that she was dying,’ says Colin. Not least because the next day, after an appointment with the cancer specialist, she was referred to hospice care.

It was not her doctors but Valerie herself who first put what was imminent into words. ‘Back at home, Valerie told me she was dying and I had to accept it,’ recalls Colin. That was when she asked him to be her soul midwife, ensuring her dying days were as she wanted them.

CARERS TO EASE THE LAST DAYS
Soul midwifery is a unique approach to end-of-life care.

In the words of Felicity Warner, the woman who founded it, ‘just as a birth midwife ensures a safe delivery into this world, the soul midwife’s role is to do the same for the dying, to make a good death possible, a dignified, peaceful and even enriching experience’.

This means ‘providing comfort, continuous support and reassurance’ — in practice, after a terminal diagnosis, this involves helping to support the patient as they make an end-of-life plan.

In the final stages the soul midwife might sit by the dying person, holding their hand, playing soothing music and burning appropriate oils. Krista Hughes, a soul midwife based in Chertsey, Surrey, works privately in people’s homes but is often called to a hospice, she says, to work with those with ‘terminal agitation’.

It is a term recognised by clinicians and often managed with sedatives, but as a soul midwife, she prefers gentle breathing, maintaining eye contact and softly repeating the person’s name.

The work of soul midwives was recognised when Felicity Warner was named 2017 End of Life Care Champion by the National Council for Palliative Care and the Royal College of Nursing. The seed for soul midwifery was planted more than 20 years ago when Felicity, now 58, was working as a journalist and interviewed several women dying of breast cancer.

The women told ‘how lonely it felt to be dying despite their medical care and their families around them’.

Not only were their doctors and nurses too busy to talk about death and dying but, surprisingly, Felicity found the women were becoming increasingly distant from friends and family who couldn’t cope with the reality and masked it with platitudes such as: ‘You’ll be feeling better soon.’

Researching how people died before the rise of modern ‘curative’ Western medicine, Felicity found a range of practices ‘that had in common the fact that they respected the act of dying as a sacred time’.

She established soul midwifery in 2004, and has since trained 600 soul midwives — many already have a health practitioner qualification — with an initial three-day course, followed by an apprenticeship lasting around a year.

Qualified soul midwives’ costs are in line with local rates for services such as counselling, though many also work as volunteers at hospices or use the qualification to help care for a terminally ill relative.

Valerie herself had attended a three-day soul midwives’ course shortly after recovering from the cancer surgery in August 2014.

‘It was something she thought she would like to do one day when she was stronger,’ recalls Colin.

So when Valerie told him she thought death might be near, he asked if she wanted him to contact the organisation to arrange for a soul midwife to visit.

Instead, she told him to read her copy of the soul midwives’ handbook so he could take on the role.

For Colin, this meant as well as ensuring Valerie’s comfort, he was her gatekeeper.

While many people want strong intravenous pain control in their last days, Valerie didn’t — ‘she wasn’t in much pain and wanted clarity of thought to the end, yet it took time and effort to stop the palliative care team administering the sedatives,’ says Colin.

‘I had to contact Valerie’s GP and get him to approve her decision, then inform the hospice nurses.’

Three days before she died, the couple celebrated their 17th wedding anniversary. ‘We wrote cards for each other and exchanged presents. The next morning, Valerie told me she had stayed for our anniversary and now she was ready to go. It was her time to die.

‘She had told me she wanted to imagine she was floating away on a boat and asked me to play soothing background music. I lit candles and used essential oils.

‘She had also warned me that the last sense to go would be her hearing, so I read prayers and spiritual affirmations.’

Soul midwifery will not be for everyone. But Colin is in no doubt that it helped Valerie to a comfortable and tranquil death.

‘Of course I longed for a last-minute reprise, a miracle recovery that would keep her with me. But I recognised that Valerie knew what her body was telling her, and did my best to concentrate on our time well spent together. I’m certain she knew that, and appreciated it.’

Complete Article HERE!

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03/30/17

Why losing a dog can be harder than losing a relative or friend

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Dogs are a huge part of their owners’ routines – which makes their loss even more jarring.

by

Recently, my wife and I went through one of the more excruciating experiences of our lives – the euthanasia of our beloved dog, Murphy. I remember making eye contact with Murphy moments before she took her last breath – she flashed me a look that was an endearing blend of confusion and the reassurance that everyone was ok because we were both by her side.

When people who have never had a dog see their dog-owning friends mourn the loss of a pet, they probably think it’s all a bit of an overreaction; after all, it’s “just a dog.”

However, those who have loved a dog know the truth: Your own pet is never “just a dog.”

Many times, I’ve had friends guiltily confide to me that they grieved more over the loss of a dog than over the loss of friends or relatives. Research has confirmed that for most people, the loss of a dog is, in almost every way, comparable to the loss of a human loved one. Unfortunately, there’s little in our cultural playbook – no grief rituals, no obituary in the local newspaper, no religious service – to help us get through the loss of a pet, which can make us feel more than a bit embarrassed to show too much public grief over our dead dogs.

Perhaps if people realized just how strong and intense the bond is between people and their dogs, such grief would become more widely accepted. This would greatly help dog owners to integrate the death into their lives and help them move forward.

An interspecies bond like no other

What is it about dogs, exactly, that make humans bond so closely with them?

For starters, dogs have had to adapt to living with humans over the past 10,000 years. And they’ve done it very well: They’re the only animal to have evolved specifically to be our companions and friends. Anthropologist Brian Hare has developed the “Domestication Hypothesis” to explain how dogs morphed from their grey wolf ancestors into the socially skilled animals that we now interact with in very much the same way as we interact with other people.

Perhaps one reason our relationships with dogs can be even more satisfying than our human relationships is that dogs provide us with such unconditional, uncritical positive feedback. (As the old saying goes, “May I become the kind of person that my dog thinks I already am.”)

This is no accident. They have been selectively bred through generations to pay attention to people, and MRI scans show that dog brains respond to praise from their owners just as strongly as they do to food (and for some dogs, praise is an even more effective incentive than food). Dogs recognize people and can learn to interpret human emotional states from facial expression alone. Scientific studies also indicate that dogs can understand human intentions, try to help their owners and even avoid people who don’t cooperate with their owners or treat them well.

Not surprisingly, humans respond positively to such unrequited affection, assistance and loyalty. Just looking at dogs can make people smile. Dog owners score higher on measures of well-being and they are happier, on average, than people who own cats or no pets at all.

Like a member of the family

Our strong attachment to dogs was subtly revealed in a recent study of “misnaming.” Misnaming happens when you call someone by the wrong name, like when parents mistakenly calls one of their kids by a sibling’s name. It turns out that the name of the family dog also gets confused with human family members, indicating that the dog’s name is being pulled from the same cognitive pool that contains other members of the family. (Curiously, the same thing rarely happens with cat names.)

It’s no wonder dog owners miss them so much when they’re gone.

Psychologist Julie Axelrod has pointed out that the loss of a dog is so painful because owners aren’t just losing the pet. It could mean the loss of a source of unconditional love, a primary companion who provides security and comfort, and maybe even a protégé that’s been mentored like a child.

The loss of a dog can also seriously disrupt an owner’s daily routine more profoundly than the loss of most friends and relatives. For owners, their daily schedules – even their vacation plans – can revolve around the needs of their pets. Changes in lifestyle and routine are some of the primary sources of stress.

According to a recent survey, many bereaved pet owners will even mistakenly interpret ambiguous sights and sounds as the movements, pants and whimpers of the deceased pet. This is most likely to happen shortly after the death of the pet, especially among owners who had very high levels of attachment to their pets.

While the death of a dog is horrible, dog owners have become so accustomed to the reassuring and nonjudgmental presence of their canine companions that, more often than not, they’ll eventually get a new one.

So yes, I miss my dog. But I’m sure that I’ll be putting myself through this ordeal again in the years to come.

Complete Article HERE!

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03/29/17

What Our Cells Teach Us About a ‘Natural’ Death

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Effigies in Scotland from the 17th century, when death was simpler.

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Every Thursday morning on the heart transplant service, our medical team would get a front-row seat to witness an epic battle raging under a microscope. Tiny pieces of heart tissue taken from patients with newly transplanted hearts would be broadcast onto a gigantic screen, showing static images of pink heart cells being attacked by varying amounts of blue immune cells. The more blue cells there were, the more voraciously they were chomping away the pink cells, the more evidence that the patient’s inherently xenophobic immune system was rejecting the foreign, transplanted heart.

There was so much beauty to be found in the infinitesimal push and pull between life and death those slides depicted that I would fantasize about having them framed and put up in my house. Yet the more I studied those cells, the more I realized that they might have the answers to one of the most difficult subjects of our time.

Throughout our history, particularly recently, the human race has looked far and wide to answer a complex question — what is a good death? With so many life-sustaining technologies now able to keep us alive almost indefinitely, many believe that a “natural” death is a good one. With technology now invading almost every aspect of our lives, the desire for a natural death experience mirrors trends noted in how we wish to experience birth, travel and food these days.

When we picture a natural death, we conjure a man or woman lying in bed at home surrounded by loved ones. Taking one’s last breath in one’s own bed, a sight ubiquitous in literature, was the modus operandi for death in ancient times. In the book “Western Attitudes Toward Death,” Philippe Ariès wrote that the deathbed scene was “organized by the dying person himself, who presided over it and knew its protocol” and that it was a public ceremony at which “it was essential that parents, friends and neighbors be present.” While such resplendent representations of death continue to be pervasive in both modern literature and pop culture, they are mostly fiction at best.

This vision of a natural death, however, is limited since it represents how we used to die before the development of modern resuscitative technologies and is merely a reflection of the social and scientific context of the time that death took place in. The desire for “natural” in almost every aspect of modern life represents a revolt against technology — when people say they want a natural death, they are alluding to the end’s being as technology-free as possible. Physicians too use this vocabulary, and frequently when they want to intimate to a family that more medical treatment may be futile, they encourage families to “let nature take its course.”

Yet, defining death by how medically involved it is might be shortsighted. The reason there are no life-sustaining devices in our romantic musings of death is that there just weren’t any available. Furthermore, our narratives of medical technology are derived largely from the outcomes they achieve. When death is unexpectedly averted through the use of drugs, devices or procedures, technology is considered miraculous; when death occurs regardless, its application is considered undignified. Therefore, defining a natural death is important because it forms the basis of what most people will thus consider a good death.

Perhaps we need to observe something even more elemental to understand what death is like when it is stripped bare of social context. Perhaps the answer to what can be considered a truly natural death can be found in the very cells that form the building blocks of all living things, humans included.

Though we have known for more than a century how cells are created, it is only recently that we have discovered how they die. Cells die via three main mechanisms. The ugliest and least elegant form of cell death is necrosis, in which because of either a lack of food or some other toxic injury, cells burst open, releasing their contents into the serums. Necrosis, which occurs in a transplanted heart undergoing rejection, causes a very powerful activation of the body’s immune system. Necrosis, then, is the cellular version of a “bad death.”

The second form of cell death is autophagy, in which the cell turns on itself, changing its defective or redundant components into nutrients, which can be used by other cells. This form of cell death occurs when food supply is limited but not entirely cut off, such as in heart failure.

The most sophisticated form of cell death, however, is unlike the other two types. Apoptosis, a Greek word used to describe falling leaves, is a programmed form of cell death. When a cell becomes old or disrepair sets in, it is nudged, usually by signaling molecules, to undergo a form of controlled self-demolition. Unlike in necrosis, the cell doesn’t burst, doesn’t tax the immune system, but quietly dissolves. Apoptosis is the reason our bone marrow doesn’t weigh two tons or our intestines don’t grow indefinitely.

As important as apoptosis is to death, it is essential for life. While as humans, we often consciously or unconsciously hope to achieve immortality, immortality has a very real existence in the cellular world — it’s called cancer. In fact, most cancers occur because of defects in apoptosis, and most novel cancer therapies are designed to allow cell death to occur as it normally would.

In many ways, therefore, life and death at a cellular level are much more socially conscious than how we interface with these phenomena at a human level. For cells, what is good for the organism is best for the cell. Even though cells are designed entirely to survive, an appropriate death is central to the survival of the organism, which itself has to die in a similar fashion for the sake of the society and ecosystem it inhabits.

We humans spend much of our lives denying death. Death, however, is not the enemy. If there is an enemy, it is the fear that death arouses. The fear of death often induces us to make choices that defy the biological constraints of our existence. Such choices often lead us to a fate that more closely resembles necrosis, involving the futile activation of innumerable resources eventually resulting in a cataclysmic outcome, rather than apoptosis. Furthermore, even as we hope to defy our mortality, our cells show the devastation that can occur for the organism if even one cell among billions achieves immortality.

When I asked Robert Horvitz, the Nobel Prize-winning biologist at the Massachusetts Institute of Technology who was part of the group that discovered apoptosis, what lessons we could learn from cell death, his answer demonstrated exactly why we have failed to understand death in the context of our lives: “Only once before has someone approached me to discuss the existential questions that might relate what is known about cell death to human existence.”

The question for us, then, is: What is the human equivalent of apoptosis in the context of our society? One way to approach that question is to look at what the human equivalent of necrosis is. To me, if a human being is in the hospital with intensive, life-sustaining therapies such as artificial respiration, nutrition or dialysis sustaining them with little hope of recovering reasonable brain function, such a state could be considered necrosis. Almost any other alternative, whether one dies in the hospital having rescinded resuscitation or intubation (DNR/DNI), at home with hospice services or with the aid of a physician’s prescription, has much more in common with apoptosis.

We have striven endlessly to answer some of our most crucial questions, yet somehow we haven’t tried to find them in the basic machinery of our biology. Apoptosis represents a pure vision of death as it occurs in nature, and that vision is something we might aspire to in our own deaths: A cell never dies in isolation, but in clear view of its peers; it rarely dies of its own volition; a greater force that is in touch with the larger organism understands when a cell is more likely to harm itself and those around it by carrying on. Apoptosis represents the ultimate paradox — for the organism to survive, the cells must die, and they must die well. “There are many disorders in which there is too little apoptotic death,” Dr. Horvitz said, “and in those cases it is activating apoptosis that could increase longevity.”

And finally, a cell also understands better than we humans do the consequences of outlasting one’s welcome. For though humanity aspires to achieve immortality, our cells teach us that a life without death is the most unnatural fate of all.

Complete Article HERE!

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03/28/17

Is there really life after death?

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Brain activity is recorded 10 MINUTES after patient dies in an ‘unexplained’ case

Scientists from from the University of Western Ontario in Canada studied the extraordinary case of a patient continuing to release delta wave bursts after they were declared dead. We normally get these delta waves during a deep sleep

By Phoebe Weston

Life may continue even after death – just in sleep mode.

Doctors have found scientific evidence that people’s brains can continue to work after they are clinically dead.

A patient showed persistent brain activity for ten minutes after their heart stopped and experienced brain waves we normally get during deep sleep.

Doctors in a Canadian intensive care unit described the case as extraordinary and unexplained.

Researchers from the University of Western Ontario in Canada assessed electric impulses in the brain in relation to the beating of someone’s heart after life-sustaining therapy was removed.

Brain inactivity preceded the heart stopping in three of the four cases.

However, in one of the cases, the patient’s brain continued to work after their heart stopped.

‘In one patient, single delta wave bursts persisted following the cessation of both the cardiac rhythm and arterial blood pressure (ABP),’ the researchers said

There was significant differences in electrical activity in the brain between the 30-minute period before and the 5-minute period after the heart stopped.

‘It is difficult to posit a physiological basis for this EEG [brain] activity given that it occurs after a prolonged loss of circulation’, according to the paper which was published in the National Centre for Biotechnology Information.

Across the four patients recordings of their brain were very different – suggesting we all experience death in unique ways.

The experiment raises difficult questions about when someone is dead and therefore when it is medically and ethically correct to use them for organ donation.

As many as a fifth of people who survive cardiac arrests report having had an other-worldly experience while being ‘clinically’ dead.

However, scientists say it’s far too early to be talking about what this could mean for the post-death experience – especially considering it was only seen in one patient, according to Science Alert.

In 2013, a similar phenomenon was investigated on experiments on rats whose hearts had stopped.

In one of the cases, single delta wave bursts persisted after the heart had stopped and the patient was clinically dead. The experiment raises difficult questions about when someone is dead and therefore when it is medically and ethically correct to use them for organ donation

The research, which was published in the journal Proceedings of the National Academy of Sciences revealed rats had a burst of brain activity one minute after decapitation.

The pattern of activity was similar to that seen when the animals were fully conscious – except signals were up to eight times stronger.

The researchers said that the discovery that the brain is highly active in the seconds after the heart stops suggests that the phenomenon has a physical, rather than spiritual nature.

It has been argued that the dying brain is incapable of such complex activity and so near-death experiences must have their origins in the soul.

It suggests something happens at the brink of death that pushes the conscious brain to a high level of arousal, potentially triggering the visions and sensations associated with near-death experiences (NDEs).

As many as a fifth of people who survive cardiac arrests report having had an other-worldly experience while being ‘clinically’ dead.

Typically NDEs involve travelling through a tunnel towards an intense light, being separated from the body, encountering long-departed loved ones or angels and undergoing some kind of judgment of ‘life review.

Some emerge from NDEs as transformed individuals with a completely altered outlook on life, or a new belief in religion.

But many scientists believe near-death-experiences are nothing more than hallucinations induced by the effect of the brain shutting down.

Complete Article HERE!

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03/27/17

The teacher gets schooled on the question of death

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Norris Burkes

By Norris Burkes

First, I need to assure you that my wife, Becky, only wears dead things around her neck during S-week. That’s the week she challenges her pre-kindergarten class of 4-year-olds to wear something that starts with the letter “S.”

The dead thing was a necklace her brother made from snake vertebrae and turquoise. It must sound terribly gross to the uniformed, but believe me it was a real attention-getter when she taught fourth grade.

Last year during S-week, my wife stood fingering her serpentine skeleton and asked, “Class, who knows what this is?”

 

One kid said, “Your fingers,” but that’s how literally little guys think.

“No,” Becky said. “This is a necklace made of snake bones, ‘Ssss,’ ” she said, making the snake hiss. “S-nake for S-week.”

“Ewww. Is it dead?” asked a prissy girl in the front row.

“Yes.”

“How did it die, Ms. Burkes?”

“Things just die,” she said with a dismissive inflection.

The kids seemed unprepared for that word “die,” so I’m guessing “dead” never came up during D-week.

“Aww,” exclaimed a sympathetic boy.

“Do squirrels die?” asked a kinetic boy who often chases the figurative squirrels.

“Yes,” my wife said slowly. She was beginning to see this line of questioning as a stacked deck.

Hoping to draw a better hand, Becky called on a favorite, little Brayden, whose parents she sees regularly at the gym.

Braydon put his cards face up on the table. “Do people die?”

“Yes. Every living thing dies eventually,” she explained.

Just then, an eerie stillness paralyzed their up to now wiggly bodies. My wife offered what she hoped would be one last touching example. “My mom died.”

“Is my mom going to die?” Brayden asked.

“Oh, don’t worry.” Becky said. “My mom was much older than your mom.”

Of course, the question no one would dare ask was, “Will I die, too?”

As a hospice chaplain, I can tell you that the unquestionable answer to that unasked question is “yes.”

As we move through the holy season of Lent, we recall the wisdom of the one who made it clear that he was going to die. He knew the timing of his death and he knew how he would die. Yet his followers resisted his predictions despite his saying, “It’s appointed unto a man once to die and after this the judgment.”

Since those words were first recorded, many seek to emphasize the judgment part. Yet, I think there’s a deeper meaning. Jesus was calling us to live our lives with a heightened sense of expectation and joy. He wants us to live at peace with all men as well as our God.

Alcoholics Anonymous calls this kind of life, “Keeping your side of the street clean.” That means we can’t predict our lifespan, but we can choose the way we live our lives.

Still searching for meaning, those kids kept drilling their teacher.

“My grandmother is old,” chimed one. “Is she going to die?”

My wife had reached a dead end. This was the moment every public speaker knows, the point stage actors describe as “dying out there.”

She thought about quoting Ecclesiastes, “To everything there is a season … a time to be born and time to die.” But instead, she glanced at her watch and said, “Oh my, kids! It’s time for recess!”

Complete Article HERE!

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03/26/17

Hospital volunteers unlock deep mysteries with dying patients

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David Wynn, left, Edie Bennett, right, and Carolyn Lyon, center, are volunteers in the St. Joseph Hospital NODA program in Orange. No One Dies Alone is to provide a reassuring presence to patients who would otherwise be alone.

by DAVID WHITING

There is life and death and the in-between.

It is the in-between where hospital volunteers such as Edie Bennett and David Wynn make sure that no one dies alone.

Over nearly a decade of volunteering at St. Joseph Hospital of Orange, Bennett and Wynn have comforted people going gently into the night, endured sepsis many would run away from, even witnessed people crossing death’s door and suddenly reviving.

But perhaps there is nothing Bennett and Wynn say that is more comforting than hearing when someone is unresponsive humans connect on far deeper levels than you might expect.

It has to do with love. But sometimes it also has to do with jazz.

MOVEMENT OF LOVE

Family and friends gathering with someone near death is as old as humanity. But in the modern world, there is a raft of reasons dying patients face death alone.

Some have families too far away to arrive in time, some are homeless and without support, others are estranged from loved ones, some simply outlive everyone they know.

The No One Dies Alone movement traces its roots to a rainy Oregon night in 1986.

Sandra Clarke, a nurse at Sacred Heart Medical Center in Eugene, tended to an elderly dying man who asked, “Would you stay with me?’

Clarke was especially busy with six patients, according to reports, and promised she would soon be back. But by the time she returned, the man had passed on.

For years, the incident haunted Clarke. Eventually, she discussed with staff her idea of volunteers staying with dying patients. PeaceHealth, the corporate organization of Sacred Heart Medical Center, approved her vision and in 2001 No One Dies Alone was born.

Today, an estimated 200 hospitals are involved.

Wynn first thought about dying alone when he and his family happened to be in Las Vegas and a family member died while they were there. Later, he heard about No One Dies Alone through a hospital newsletter after being treated for a condition that nearly killed him. He recalled dark, sometimes scary nights when staff held his hand and comforted his worries away. “It was like I got hit on the head with a board.

“I don’t want to sound like ‘St. Dave,’ but I wanted to do something that made a difference.”

Busy with family, camping, skiing and a demanding job as an AT&T senior project manager, Wynn offered to volunteer. Soon, he was coaxed into coordinating the program.

That was nearly a decade ago.

DEEP CONNECTIONS

St. Joe’s, as the hospital is affectionately known, averages one dying alone incident a month. That may not sound like much, but keep in mind that death is unpredictable. Some people pass within a few hours, others linger for weeks — and some walk away.

Wynn recalls a woman dying one New Year’s Eve. On his way home from a ski trip with his wife, he agreed to answer the call thinking he would be home from the hospital before midnight.

But midnight stretched to 1 a.m., then 2 a.m., then 3 a.m. Dozing in a chair, Wynn woke to daylight and the woman sat bolt upright in bed asking, “Who are you?”

Wynn stammered he was simply there to keep her company.

Soon, the woman returned to her nursing home.

When a call goes out, an army of some 45 volunteers split into four-hour, round-the-clock shifts.

Wynn recalls his first patient, a woman in isolation dying of cancer. When he opened her door, the odor nearly knocked him over. He gathered himself, sat down, took a glove off and touched the woman’s arm to assure her that she was not alone.

“It’s not always pleasant. Sitting there for hours with a gown and mask on can be difficult,” Wynn, a 61-year-old Anaheim Hills resident, allows, “but every human being deserves to die with dignity.

“I think touch is very important.”

As Wynn talks, I think of my father holding my mother’s hand and caressing her arm just before Thanksgiving as she lay in a coma. As her heartbeat slowed, I too held her hand and gently kissed her forehead.

But I wondered whether we do these things to sooth our souls or for the souls of others.

Wynn is convinced communication — both sound and kinetic — goes back and forth regardless of the patient’s responsiveness.

“When I was non-responsive,” he says of his time as a patient, “I could still think, I was still aware.”

Volunteers talk, watch TV, listen to music with patients. “Each case,” Wynn explains, “takes on a life of their own. There’s a connection.”

Wynn learned one of his patients was a musician so Wynn played classical music. But the patient grew restless so Wynn turned off the music. Later, he learned the man was a jazz musician and Wynn played something off a 1959 Miles Davis album called “Kind of Blue.”

The patient’s lips crinkled into a slight smile.

‘SACRED ENCOUNTERS’

When Bennett learned her father was in the hospital in Arizona, the retired lobbyist drove eight straight hours. But she just missed being there when dad was still alive.

The event prompted the 68-year-old Orange resident to volunteer. “You’re sharing the last stage of life’s journey,” Bennett offers. “For me there’s no more sacred an encounter.”

Both Bennett and Wynn remember every patient as if it were yesterday. One was a 26-year-old woman with a long-term disease Bennett had met at St. Joe’s the year before. Back then, the woman had a tattered stuffed animal. Bennett brought a playmate, a furry toy.

“She was sipping from a straw,” Bennett recalls, “lime Jell-O. I stroked her hair. She could have been my daughter.”

Bennett looked at the young woman and promised, “You will always be my angel.”

“Thank you,” the young woman said before slipping away.

“I still think of her,” Bennett allows, “and that was almost two years ago.”

Then there was the time when Bennett was with a dying woman gasping for air. Her breathing slowed to six breaths a minute. Soon, it was so quiet it appeared she was about to take her final breath.

Suddenly, the patient muttered something. Bennett couldn’t make it out. Another sound, “water.”

Within an hour, the patient sang, “Water, water.” Then she ate chocolate pudding. Soon, she was discharged.

“It’s rare,” Bennett says, “but it does happen.”

The mystery of the in-between.

Complete Article HERE!

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03/25/17

Nursing my dying mother made me determined that everyone should have a ‘good’ death

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By Adrienne Betteley

When my mum Joan died of oesophageal cancer in 2014, she was in the place she wanted to spend her last days – the spare bedroom at home – with me and my dad, Cliff, by her side.

I’d spent the last week in a camp bed next to Mum, wiping her lips and mopping her forehead as we shared memories.

On the night she died, she put her arm around me and said “Adrienne, I have to thank you for being the most wonderful daughter.” Afterwards, our district nurse made my dad a whisky and me a cup of tea as we said our final goodbyes.

Not without serious difficulty

Mum had a ‘good death’, but not without serious difficulties at times. I can’t help thinking it was my background as a district nurse that allowed her to die at home with her family. My experience meant I was listened to, and I pushed for her to get what she needed, such as acupuncture at the local hospice to relieve her crippling pain from arthritis. I knew what to expect and what conversations to have. We had early discussions about how she wanted to die (at home, not in hospital) and where (not next to Dad in their bed), which we call Advance Care Planning in the medical profession. At Macmillan, we believe that more needs to be done to ensure people are planning for their deaths, so their wishes – such as where they die – can be met.

Sadly, a death like my mum’s is denied to so many in this country. And I believe it would have been impossible for her too, had she not happened to have a nurse for a daughter. I had to fight to get her the care she desperately needed. Services are depleted, especially out of hours. You can’t choose when advanced cancer will cause you pain, but getting pain-relief at night or on weekends can be impossible. In her final days, there was no availability for a night sitter. Thankfully, I could be by her bedside, but had I not been, I’m convinced she would have died in hospital against her wishes.

Findings published in the British Medical Journal last week help explain why some people aren’t getting enough support when they are dying. Care for dying people varies hugely across different regions, both in how much money services are allocated and what care they offer. Figures suggested that, in most parts of the country, there are no specialist pain control teams, and, where they are in place, most operate only in normal working hours with no cover overnight. Until you’ve had a loved one in pain, with no way of providing them relief, it’s hard to appreciate the urgency of this situation.

Having a choice

Pain relief is the very least we should expect at the end of our lives. But it’s also important that, where possible, patients can die in a place of their choosing. We know that most people with advanced cancer would prefer to die at home, but not many of them actually do. Without round-the-clock community nursing, it’s hard to see how this will improve.

My days as a district nurse taught me that getting things right for people at the end of their life takes time. Decisions made about treatment affect how that person will spend their last months, weeks, hours, in this world. But time is something our overstretched workforce doesn’t have. Last month came another heart-breaking revelation – that over two thirds of nurses ‘don’t have time’ to care for dying patients. Is this really what we’ve come to? Something has to change.

Painless death must be priority

I know what a good death looks like, and that it is achievable. But to give everyone a chance to die without pain, and in the place they want to, care for dying people needs to be a priority across the country. As the NHS and local councils set out their plans to transform healthcare, it’s vitally important that they take into account how they will care for people at the end of their lives. At Macmillan, we’ll be monitoring these plans closely to make sure they do.

Those last few weeks with my mum were exhausting, but they were special and irreplaceable. Helping her in her final days with the people she loved, in the house she knew, was the most meaningful thing I’ve ever done. Caring how people die isn’t just about death, but about the value we place on life.

Complete Article HERE!

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