05/20/17

Pathologist Carla Valentine Will Teach You How to Die Fearlessly

Share

“The people who think about mortality tend to have the highest happiness rate.”

By Sarah Sloat

Ambitious technocrats may predict a deathless future, but as the world stands now, we’re all going to die. This leaves us humans with the same two options we’ve had since we emerged from the evolutionary mire: Fear the final shuffling of our mortal coils, or embrace the inevitability that we’ll all be one with the dirt.

Fortunately, there are people out there who can help ease your mind about the whole “one day you’ll be dead” thing. One of those people is Carla Valentine, whose job as an anatomical pathologist, technical curator at Barts Pathology Museum, and author of The Chick and the Dead, has more than prepared her to come face to face with the inevitable end. In her book, which will be released in the United States in June, she weaves together corpse science and her intimate involvement with the “death industry” with the vital lesson about dying she’s learned over the years: Everyone wants to learn more about death whether they admit it to themselves or not, and accepting that education is the best preparation for their final days.

Valentine, whose book will be released in the United States in June, recently spoke to Inverse about the CSI effect, the future of “soul midwives,” and urban legends that just won’t go to the grave.

Carla Valentine.

>Why was now the right time to write this book?
There are two reasons, really. There is definitely more of a desire at the moment for people to speak about death and learn more about it. That’s been on an upward trajectory. That just happened to coincide with when I left my career as a full-time pathology technician and I began to work at the museum, which gave me more free time to actually start to write.

What do you think has driven that increased interest in talking about death and learning about it?
When I first studied forensic science, which was 15 years ago, there were barely any courses. Those courses began to increase with what we call the “CSI effect”. That’s an actual academic term now for the interest in death and autopsies that has emerged from the increase in books and TV shows on the topic.

I think another issue is just the cost of funerals, like many things, is rising. People want to be a bit more informed and demystify the process around death so that they can plan properly and just dispel a lot of the myths before the time comes. There have always been a lot of myths around autopsies and how we conduct them. I think people just want to know the truth and it’s a good time for it.

What do you think people gain when from learning about what happens to their body after they die?
Personally, I think that when people face this idea of their mortality, the reality of it, and the reality of what may happen to their family members, for example, they tend to live a better life. They tend to understand how quickly it can be taken away. They can appreciate their own mortality and their own health. That was always what I felt and that’s been backed up by psychological studies, as well, which I reference in the book. The people who think about mortality tend to have the highest happiness rate. I think it’s because it demystifies it. People say that you’re afraid of the unknown. Sometimes it’s better to face the reality of it. Then it’s not so scary anymore.

Fracture of a mandible at the Pathology Museum.

Do you get consistently the same sort of questions from people when they learn about your job?
I get consistently the same sort of questions and I get consistently told the same myths. Those absolutely drive me insane. I took as much opportunity as I could to answer all of the questions that I always get asked in the book. A lot of these myths have been doing the rounds since I was a child. For example, I was at the hairdresser’s yesterday, and the girl in the chair next to me overheard that we were talking about my job, and she said, “It’s true, isn’t it, that the fingernails grow and the hair grows after death?” I was like, “No it’s not like that.” I’ve heard the same things for 20 years.

What else do people get wrong about death?
People also think the deceased sit upright because of their gases, which is not true at all. Some deceased people are possibly in a state of rigor mortis, where they’ve passed away in a chair and so that means for a while they’ll still be in a bent-over position. They’ll look slightly like they’re sitting up when they’re on the slab. But they don’t sit up because of the gases. There are the odd groans or burps or farts. That is true.

The most annoying urban legend is the one where someone tells me, “A friend of mine knows someone who got a rash and when she went to the doctors she found out that it can only be caught from a corpse.” Basically insinuating that the guy that she’d had sex with or whatever has had sex with a corpse. That always drives me insane because there’s nothing on a deceased individual that isn’t on a live individual. We have the flora and fauna. There is no such thing as a parasite or a fungus that you can get from the dead.

It just goes to show how fascinated people are by those subjects. I’m doing my MA on the relationship between the sexualized gaze and anatomical displays. When I blog about sex and death and people go, “Really?” I think, look, you’re all interested in sex and death, just look at this one urban legend that’s nearly outlived me. Clearly, people are far more interested in sex and death than they’d like to let on.

A broken cervical spine.

What is it about that intersection that people keep on coming back to?
They’ve had similar periods in time where they’ve been sort of considered taboos. But the simple fact is sex is what begins our lives and death is what ends it. They’re two sides of the same coin. They’ve always been connected to each other psychoanalytically because everything you do, according to Freud, you do with either the death drive, the morbido, or a life drive, which is libido.

Inside Barts Pathology Museum.

Are there any new modern trends you’ve noticed, when it comes to what people want immediately before and after they die?
There are definitely newer trends towards much more environmentally friendly funerals. A lot of people are moving away from the traditional funeral, and opting for a green burial. That means that they wouldn’t be embalmed. Embalming was never as big over in the United Kingdom as it is in the U.S. anyway, but it’s still definitely dwindling. Natural burials where people are placed into wicker, cardboard coffins, or linen and buried into an actual burial ground. There’s definitely an increase in people who want that, while we never really would hear of that request a few years ago.

And then there’s death doulas and end of life doulas. They’re just like midwives, but for death. I met one the other night and he actually called himself a “soul midwife.” Death doulas are usually brought in when the person is in hospice. It can also be as soon as a person discovers that they’re terminally ill. In the same way that a midwife is there for the mother as she’s becoming dilated and then she delivers the baby, the doula helps the person through the process of death. It’s a similar process, I suppose, just the other way around.

Complete Article HERE!

Share
05/18/17

New nationwide study indicates patients are often prescribed potentially futile drugs in their final days

Share

Nearly half of older adults in Sweden take 10 or more medications in their last months of life, according to a new study reported in The American Journal of Medicine

Older adults often receive drugs of questionable benefit during their last months of life, according to the first study conducted on the burden of end-of-life medications across an entire population. The authors advocate for clinical guidelines to support physicians when they face the decision to continue or discontinue medications near the end of life. Their findings are published in The American Journal of Medicine.

The simultaneous use of multiple medications has become commonplace among older adults. In high-income countries, it has previously been estimated that 25% to 40% of people aged 65 years or older are prescribed at least five medications. This practice is known as “polypharmacy,” and can lead to drug-drug interactions and serious adverse effects.

In the context of end-of-life care, polypharmacy also raises important ethical questions about the potential futility of treatments close to death.

“People with life-limiting illness often receive medications whose benefit is unlikely to be achieved within their remaining lifespan,” writes lead author Lucas Morin, of the Aging Research Center at Karolinska Institutet in Stockholm, Sweden. “However, previous studies have been conducted in selected samples of individuals. Future research and clinical guidelines need to be informed by findings that are generalizable beyond a specific illness or care setting.”

The authors identified over half a million adults over 65 years of age who died in Sweden between 2007 and 2013, and reconstructed their drug prescription history for each of the last 12 months of life through the Swedish Prescribed Drug Register. The characteristics of study participants at time of death were assessed through record linkage with the National Patient Register, the Social Services Register, and the Swedish Education Register. Of note, over-the-counter drugs were not taken into account in this investigation.

The study resulted in two main findings:

First, the burden of medications increases as death approaches. The proportion of older adults exposed to at least ten different prescription drugs rose from 30% to 47% over the course of the last year before death. Older adults who died from cancer had the largest increase in the number of drugs. Individuals living in institutions were found to receive a greater number of medications than those living in the community, but the number of drugs increased more slowly for those living in an institution.

Second, the researchers found that polypharmacy near the end of life is fueled not only by drugs prescribed for the purpose of symptom management (e.g. analgesics), but also by the frequent continuation of long-term preventive treatments and disease-targeted drugs. For instance, during their last month of life, a large proportion of older adults used platelet antiaggregants (45%), beta-blockers (41%), ACE inhibitors (21%), vasodilators (17%), statins (16%), calcium channel blockers (15%), or potassium-sparing agents (12%).

“The clinical benefit of drugs aiming at preventing cardiovascular diseases during the final month of life is at the very least questionable. Physicians should consider discontinuing drugs that may be effective and otherwise appropriate, but whose potential harms outweigh the benefits that patients can reasonably expect before death occurs.” However, the authors noted that “the process of de-prescribing requires timely dialogue between the patient, family, and physician, and close monitoring of symptoms. It is also essential that patients and their relatives receive clear information about their options in terms of palliative care in order to counter the feeling of abandonment that they may experience when treatments are withdrawn.”

The authors call for the development of clinical guidelines to support physicians in their effort to reduce potentially futile drug treatments near the end of life.

Complete Article HERE!

Share
04/27/17

Couple die holding hands after 69 years of marriage

Share

An Illinois couple married for 69 years have died within an hour of each other, family members tell US media.

Till death do us part: The couple first met in their native Argentina

Isaac Vatkin, 91, was holding the hand of his wife Teresa, 89, as she succumbed to Alzheimer’s disease on Saturday, the Daily Herald reported.

Isaac died 40 minutes later. Family members said they took comfort in knowing they were together at the end.

“You didn’t want to see them go,” said grandson William Vatkin, “but you couldn’t ask for anything more.”

The Vatkins sparkle on their wedding day

“Their love for each other was so strong, they simply could not live without each other,” said daughter Clara Gesklin at the couple’s joint funeral.

“They were always in love, literally to the end. To the last second,” said Rabbi Barry Schechter, who led the service at the Shalom Memorial Funeral Home in the Chicago suburb of Arlington Heights.

Staff at the local Highland Park Hospital found Mr and Mrs Vatkin unresponsive and breathing shallowly on Saturday and chose to place their beds side by side.

Family members positioned their hands so they touched.

The couple raised three children in Skokie, Illinois, and had a close relationship with their grandchildren, family members said.

Mr Vatkin had been a kosher meat distributor and Mrs Vatkin a homemaker and manicurist.

Complete Article HERE!

Share
04/25/17

How virtual reality is improving end-of-life care

Share

In the UK, terminally ill patients are being transported from the hospice to other worlds.

By

Virtual reality is not just for showing off the latest games and inventions. The technology has found a purpose in the healthcare industry as part of improving hospice and end-of-life care.

When someone is terminally ill, it may be inevitable that the individual will, at some point, go to a hospice or treatment center for end-of-life care or, at the least, to a respite center to give home caregivers a break.

However, in the UK under a creaking, strained, and underfunded National Health Service (NHS), sometimes these facilities may be suffering themselves from a lack of budget to make these stays as comfortable as they could otherwise be.

In addition, and perhaps most importantly, taking someone away from their home at such a stage can be a difficult transition.

To make this process a little less heartbreaking, local charity hospice Loros, which provides hospice and home care to roughly 2,500 terminally ill individuals across Leicester, Leicestershire, and Rutland, UK, has launched a new project which uses virtual reality to enhance end-of-life care.

The idea is to help those who have limited mobility to experience life outside of treatment and give them the chance to go back to places in their past which hold fond memories, as well as experience new areas beyond the hospice and home.

As shown in the video below, 70-year-old John, who is diagnosed with motor neuron disease (MND), is trying out the headset equipped with a video of Bradgate Park. This kind of technology can give patients a little more joy in their lives when perhaps it matters most.

Since being diagnosed with MND, we can get out but I can’t spend a lot of time out of the wheelchair, so being able to have these experiences through the glasses is really good,” said John. “It’s almost as good as the real thing.”

It’s a reminder that while many of us obsess over whether or not the latest mobile device will have a headphone jack or an impossibly thin shell or not, advances in technology can also provide far more important experiences.

Loros is currently working with a VR company to produce more films and hopes to commission new films that other hospice providers will be able to use in their own virtual reality services.

“Research suggests that the brain accepts the virtual world within 20 seconds after which the experience becomes all-absorbing,” Loros CEO John Knight commented. “We recognize that some of our patients are often restricted to where they can go due to their illness, so we wanted to help give them the opportunity to still enjoy life wider than their restrictions allow, through virtual reality.”

 Complete Article HERE!

Share
04/17/17

Inferior End of Life Care for Ethnic-Minority Patients With Ovarian Cancer

Share

Study findings show that “important disparities in use of end-of-life care persist among racial and ethnic minorities.”

By

African-American and Hispanic patients with ovarian cancer in Texas were more likely than Caucasian patients to suffer invasive or toxic treatment and to be admitted to the ICU in their final month of life, according to a study published in the Journal of Clinical Oncology.1

“We found being a minority was associated with receiving intensive and invasive end-of-life care among patients with ovarian cancer,” reported lead study author Jolyn S. Taylor, MD, MPH, of the University of Texas MD Anderson Cancer Center in Houston, and colleagues. “Irrespective of other sociodemographic factors, patients of black or Hispanic racial and ethnic backgrounds were less likely to meet end-of-life quality-care metrics.”

The authors analyzed data from the Texas Cancer Registry and Medicare to assess the treatments administered to 3666 patients with ovarian cancer who died between 2000 and 2012. Seventy-seven percent of the patients were Caucasian, 15% were Hispanic, and 7% were African-American. (One percent of patients were classified as “other.”) Only patients who had received 13 months of Medicare coverage before death were included in the analysis.

Most (72%) patients had been enrolled in hospice but only 64% were still enrolled when they died, the study team noted. Median enrollment was 20 days.

“In the final 30 days of life, 381 (10%) had more than one ER visit, 505 (14%) more than one hospital admission, 593 (16%) ICU admission, 848 (23%) invasive care, and 418 (11%) life-extending care,” the authors reported.

Ten percent (357 patients) received chemotherapy during the final 2 weeks of life.

Ethnic and racial disparities in end-of-life care remained statistically significant in multivariate analyses adjusting for year and age at death, tumor stage, comorbidity index, income and education level, and location of residence. Race and ethnicity correlated more strongly with outcomes than income, education, or geography.

“Several outcomes differed for minorities compared to white patients,” the authors concluded. “Hispanic and black patients were less likely to enroll and die in hospice (black odds ratio [OR] 0.66; 95% CI: 0.50-0.88; P = .004; Hispanic OR 0.76; 95% CI: 0.61-0.94; P = .01.”

Hispanic patients were also more frequently admitted to the ICU (OR 1.37; 95% CI: 1.05-1.78; P = .02), while African-American patients more frequently received multiple ER visits or underwent life-extending procedures (ORs 2.20 and 2.13, respectively; P < .001 for each).

The findings show that “important disparities in use of end-of-life care persist among racial and ethnic minorities,” the authors concluded.

Complete Article HERE!

Share
04/2/17

Where you live may determine how you die, study suggests

Share

By JoNel Aleccia

Americans who want to ensure they have a say in how they die should examine the lessons of Oregon, a new analysis suggests.

Seriously ill people in that state are more likely to have their end-of-life wishes honored — including fewer intensive-care hospitalizations and more home hospice enrollments — than those living in neighboring Washington state or the rest of the country.

In 2013, nearly two-thirds of Oregonians who died did so at home, compared with fewer than 40 percent of people elsewhere in the US, according to the report published Wednesday in the New England Journal of Medicine. Previous research had shown that more than 85 percent of Americans say they’d prefer to die at home.

“Obviously, if you’ve spent decades trying to improve your end-of-life care, it’s pretty rewarding to see that something changes,” said Dr. Susan Tolle, director of the Center for Ethics in Health Care at the Oregon Health and Science University in Portland, who co-led the study.

The review analyzed Medicare fee-for-service claims data from 2000, 2005, and 2013, and it compared end-of-life care in Oregon and Washington — a nearby state with similar demographics and attitudes toward end-of-life care — with the rest of the US, excluding those two states.

It found that in 2013, ICU use in the last 30 days of life was about 18 percent in Oregon, compared with 23 percent in Washington and 28.5 percent in the rest of the US. Nearly three-quarters of patients in Oregon hospitalized in the last month of life were discharged to home, compared with slightly fewer than two-thirds in Washington state and a little more than half — 54.2 percent — in the rest of the US.

More than 40 percent of patients in Oregon were enrolled in home hospice in 2013, compared with about 30 percent in Washington and fewer than 20 percent in the rest of the US, the analysis found.

Oregon, which enacted the nation’s first death-with-dignity law and led the way on implementing portable medical orders for treatment at the end of life, may be reaping the results of those and other efforts, said Tolle’s coauthor, Dr. Joan Teno, a professor of medicine, gerontology, and geriatrics at the University of Washington in Seattle.

“When you look at the patterns, it’s very different than the rest of the United States,” she said. “It’s even different than a borderline state.”

Pat Duty, 64, who ran a Portland floor-covering business with her husband, Jimmy, for years, said Oregon’s palliative care culture helped guide treatment decisions after his 2013 diagnosis of lung cancer and dementia. Jimmy Duty wanted limited medical interventions; he had a do-not-resuscitate order, plus a request to avoid the ICU.

“He was very clear that quality of life was his first choice,” Pat Duty recalled. “We knew we needed to discuss these things while he could make decisions for himself. We wanted to give him the dignity and grace he deserved for his final couple of years.” He died in October 2015 at age 74.

Creating such a culture is much harder than it looks, Tolle and Teno argued. Oregon has successfully integrated awareness of end-of-life care at all levels, from state government and emergency care to individual decisions made by patients and their doctors.

“If patients’ goals are not linked to actionable care plans that are supported by local health care systems and state regulations, many patients who wish to remain at home will die intubated for all the reasons the current system fails them,” they wrote.

Across the US, there’s been a push to promote ways to indicate end-of-life treatment preferences, including advance directives, which provide guidance for future care, and Physician Orders for Life-Sustaining Treatment, or POLST, portable medical orders authorizing current care. Twenty-two states now have POLST programs and others are working on or considering them, said Tolle, who co-led the creation of POLST in the early 1990s.

But the researchers warned that, while POLST efforts are important, simply filling out the forms is not enough.

“We were highlighting that there’s no simple answer,” Tolle said. “You can’t just do one thing and think that you will change the culture of end-of-life care. It is a whole lot of work.”

Dr. Scott Halpern, a medical ethics and health policy expert at the Perelman School of Medicine at the University of Pennsylvania, has been a chief critic of POLST efforts, contending that there’s little evidence that the medical orders improve quality of life near death.

The new analysis by Tolle and Teno doesn’t fill the gap, he said. But he agreed with the authors’ contention that a focus on single interventions ignores the complexity of end-of-life decisions.

“Good end-of-life care involves physicians eliciting patients’ values, hopes and fears and making treatment decisions that align,” Halpern said.

The new analysis, which was funded by a grant from the Robert Wood Johnson Foundation, underscores that families and patients outside of Oregon must be vigilant to ensure they receive the care they want, Tolle said.

“The level of care you receive near the end of life depends more on the state you live in and the systems they have in place than your actual wishes,” she said.

Complete Article HERE!

Share
03/28/17

Is there really life after death?

Share

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!

Share