Patients, doctors, and the power of religious faith

By Dr. Suzanne Koven

In the lobby of the hospital where I did my medical training stands a 10½-foot marble statue of Jesus. Patients and visitors often pause before the imposing figure to gather their thoughts, pray, or just touch its smooth white foot. The hospital has always been secular, but the statue has brought comfort to thousands for over a hundred years. It also reminds doctors that, in medical matters, our patients do not necessarily see us as the final authority.

praying_handsSeveral surveys show that over 90 percent of Americans believe in God. It’s not surprising, then, that religion plays an important role in medical care. Just as there are no atheists in foxholes, a nonbeliever might reconsider while being rolled into the operating room or waiting for a biopsy result.

The clinical efficacy of prayer is difficult to measure, though researchers have tried. In one study, strangers were instructed to pray for patients undergoing heart surgery. The prayers did not seem to improve the patients’ outcomes. Interestingly, if the patients were told they were being prayed for, they had more postoperative complications.

Still, there’s no question that prayer benefits many people. Prayer, like meditation, can lower blood pressure and anxiety and put patients in a more positive frame of mind. Even doctors like me who are not religious appreciate the element of mystery in medicine; an unexplainable force that seems, at times, to aid recovery. I was discussing this recently with a patient of mine who is a nun. She pointed out that what I call a coincidence she calls a GOD-incidence — even though we might be talking about the same thing.

On many occasions I have found myself humbled and inspired by my patients’ religious faith, even when I did not share it and even when it did not produce a cure.

One devout woman in her 50s who was dying of uterine cancer made an appointment with me to discuss what she had only identified on the phone as “plans.” I assumed she meant hospice care, DNR orders, and pain management. But what she had in mind was none of these. She told me, matter-of-factly, that she had no fear of death, that she fully expected to be reunited in heaven with her late father, and that she looked forward to this.

She did, however, have some loose ends to tie up before then, including arranging for the care of her mother, an elderly woman who was also my patient. In a very organized and business-like way she told me that she intended to move her mother in with a cousin, and enlisted my help in transferring her medical care to a physician closer to her new home — or, her next-to-last home, the one she’d inhabit before she too arrived in heaven.

I found myself full of admiration for this woman, and envious of her, too. I could not imagine having this kind of equanimity myself, faced with a hereafter about which I did not share her certainty. I had to admit that God offered her more beneficial “end-of-life counseling” than I ever could.

Another time, I found myself in a diagnostic dispute with God. A middle-aged woman developed a series of neurological symptoms. Neither I nor several specialists could determine their cause. The patient, on the other hand, was quite sure that she had chronic Lyme disease. She’d had a divine vision one night, in which the word LYME appeared in large letters. For a few years she took antibiotics continuously, prescribed by a doctor who treats chronic Lyme.

Unfortunately, her symptoms progressed, and she ultimately proved to have ALS, or Lou Gehrig’s Disease. After the woman died, I reflected that while her vision had been misleading, it had brought her hope during the last years of her life — hope that she would not have enjoyed if she’d known from the start that she had ALS.

Occasionally, even I wonder if an event can be purely coincidence.

Years ago, I headed out of town on vacation, neglecting to tell a hospitalized patient of mine that I would not see her for several days. I had arranged for one of my partners to care for her, of course, but worried about whether she would feel I’d abandoned her. This was before the era of cellphones, and the pay phone at the seaside motel where I was staying was broken. I decided that it really wasn’t necessary to call my patient and went for a walk on the beach.

By the water, coming toward me, emerging through the bright sunlight, was a man wearing a T-shirt with a single word imprinted on it: my patient’s last name. I left the beach and found another pay phone. She was doing fine, and was happy to hear from me.

My patient the nun once asked if I might visit her mother, also my patient, at home when the older woman was near the end of her life. She asked if I would draw her mother’s blood during my house call.

I was a crackerjack phlebotomist back when I was an intern, but it had been years since I’d drawn blood and told her I might be rusty. That was OK, she said. She had faith in me.

I dusted off my black doctor’s bag, threw in a needle, some tubes, alcohol wipes and a tourniquet, and headed to my patient’s house. When the time came to draw the woman’s blood, I had trouble finding a vein.

“You can stick her again if you need to,” said the daughter kindly. I confessed that I’d brought only one needle.

“Then, doctor,” said the nun, “I will pray for you.”

I adjusted the needle slightly, and a flash of red appeared. I turned to the patient’s daughter, seeking her approval. But her eyes were not on me.

They were lifted to the sky.

Complete Article HERE!

Is Death The Enemy?

“In the end, the marginal status our culture assigns to the end of life, with all its fear, anxiety, isolation and anger is inevitably what each of us will inherit in our dying days if we don’t help change this unfortunate paradigm.”

 

For many healing and helping professionals, death is the enemy. That doesn’t come as much of a surprise really. Everything in our training, as well as everything in our culture, underscores that mindset. But this principle can actually be counterproductive more often than we realize. I am of the mind that if we encounter our mortality in an upfront way, we will be able to demonstrate genuine compassion to our patients and clients as they face theirs.hospitalbed

Here are some things we might want to consider if encountering mortality is our goal:

  • Death isn’t only a universal biological fact of life, it’s also a necessary part of being human. Everything that we value about life and living — its novelties, challenges, opportunities for development — would be impossible without death as the defining boundary of our lives.
  • While it may be easier to accept death in the abstract, it’s often more difficult to accept the specifics of our own death. Why must I die like this, with this disfigurement, this pain? Why must I die so young? Why must I die before completing my life’s work or before providing adequately for the ones I love?
  • Living a good death begins the moment we accept our mortality as part of who we are. We’ve had to integrate other aspects of ourselves into our daily lives – our gender, racial background, and cultural heritage, to name a few. Why not our mortality? Putting death in its proper perspective will help us appreciate life in a new way. Facing our mortality allows us to achieve a greater sense of balance and purpose in our life as well.
  • Dying can be a time of extraordinary alertness, concentration, and emotional intensity. It’s possible to use the natural intensity and emotion of this final season of life to make it the culminating stage of our personal growth. Imagine if we could help our sick, elder, and dying clients and patients tap into this intensity. Imagine if we had this kind of confidence about our own mortality.

We healing and helping professionals can actually help pioneer new standards of a good death that our patients and clients can emulate. We are in a unique position to help the rest of society desensitize death and dying. And most importantly, we would be able to support our patients and clients, as well as those they love, as they prepare for death. We could even join them as they begin their anticipatory grieving process.EndOfLifeCareSOS024HIRESsmall

If we face our mortality head-on we will understand how difficult it is for our sick, elder, and dying patients and clients. We will be more sensitive to their striving to regain lost dignity by actively involving themselves in the practical preparations for their own death. If we can project ourselves to the end of our lives we will better understand our patients and clients as they try to negotiate pain management, choose the appropriate care for the final stages of their dying, put their affairs in order, prepare rituals of transition, as well as learn how to say goodbye and impart blessings.

Facing our mortality may even allow us to help our patients and clients learn to heed the promptings of their mind and body, allowing you to move from a struggle against dying to one of acceptance and acquiescence.

In the end, the marginal status our culture assigns to the end of life, with all its fear, anxiety, isolation and anger is inevitably what each of us will inherit in our dying days if we don’t help change this unfortunate paradigm.

End-of-life care: ‘Shortfall in NHS services’

By Nick Triggle

There is a shortage of specialist end-of-life care in England, causing unnecessary suffering, experts say.

ENDOFLIFEPeople dying with the most complex conditions, such as cancer, dementia and heart and liver failure often need support from a range of professionals.

But a report – produced by end-of-life doctors and nurses – said many were going without the help they needed.

As well as being an inefficient use of NHS money, this could be causing greater distress at death, they said.

Specialist end-of-life care requires teams of professionals, including doctors, nurses, social workers, psychologists and pharmacists to work together to help manage pain and disability in the final year of life and ensure patients are treated with dignity and compassion.

As well as helping to achieve as comfortable a death as possible, the support can also reduce costs to the NHS by keeping people out of hospital, said the report, produced by a host of specialist bodies including the Association of Palliative Medicine and Marie Curie Cancer Care.

‘Paralysis’
Not everyone who dies needs such help as some deaths are sudden or unexpected.

Continue reading the main story

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Palliative care has the ability to save the NHS money and improve the care of patients”

Dr David Brooks
Association of Palliative Medicine
But the ageing population means there is a growing number of people with complex, long-term problems that need carefully managing at the end of life.

The report said it was estimated that between 160,000 to 170,000 people a year were currently receiving specialist end-of-life care.

The groups said this was a “significant” shortfall on the numbers who needed help. It said more than 350,000 people required some form of end-of-life care, the majority of whom would benefit from specialist care.

Dr David Brooks, vice-president of the Association of Palliative Medicine, said: “There is a shortfall in services that needs to be addressed. Palliative care has the ability to save the NHS money and improve the care of patients.”

It comes after there has been mounting concern about one part of end-of-life care, the Liverpool Care Pathway.

Complaints
At the end of last year there were suggestions the regime, which allows doctors to withdraw treatment in the last days of life, was being misused in places.

Relatives of dying patients had complained that their loved ones had been put on the pathway without consent.

Professionals working in the field had agreed to launch a review into how the system was working, but that was then put on hold when ministers said it should be done independently.

That review has yet to start, although the government is expected to announce details of it in the coming weeks.

Dr Brooks said the profession was keen to find out what had gone wrong, but he said the controversy and wait for the review had created a “bit of paralysis”.

“It is important we get this right and tackle what was happening, but there is a little frustration it is taking some time.”

Complete Article HERE!

On The Radio with Chris MacLellan — Tuesday, 01/08/13

I’m delighted to announce that I will be sharing the airwaves with my friend and colleague, Chris MacLellan, from Be A Healthy Caregiver fame.  We’ll be on blogtalkradio Tuesday, 01/08/13 at 1:00pm eastern time and 10:00am west coast time.

Find all the information HERE!

Come and join the conversation; you’ll be so glad you did!

And be sure to visit Chris on his site, The Purple Jacket and follow him on Twitter @TheBowTieGuy.

See Ya Tuesday!

healthy caregiver

How we can change end-of-life medicine

A gift Americans owe to themselves and their country in 2013 is lessons on how to die.

our-livesDoctors know this. They don’t spend their final hours like the other 2.4 million Americans who die every year. They’ve seen patients hooked up to tubes in hospital beds, suffering unnecessary pain and indignity, while tens of thousands of dollars are spent on every medical option to extend lives that are clearly near the end. According to a Johns Hopkins study, most doctors have advance care directives, reject CPR and live their final days with dignity, at home and in hospice, surrounded by loved ones.

The Mercury News’ Lisa M. Krieger has spent the past year grappling with our approach to death in America. Her insightful, heartfelt series, “Cost of Dying,” concludes Sunday with a practical analysis of how to change end-of-life medicine. She encourages us to take charge of our own deaths, tell doctors what we want, reject treatments that we really know can’t help and — this is most important — consider suffering, not death, the enemy. Expanding access to hospice care is a key to all this.

Pain can be managed very well today. Most Americans could die in peace at home. But nearly 80 percent die in hospitals or nursing homes, even though surveys show these are the last places the vast majority wants to be. About 20 percent die connected to tubes in intensive care units, the least humane and most expensive end of life care.

We need a culture change in our approach to death. We need to focus more on dying with dignity and less on extending life to the last possible minute. This will be better for individuals, and it will be better for America: Our health care costs are killing our economy, and pointless end-of-life care is a big part of the reason.

This country spends nearly twice as much per capita on health care as any of its competitors in world markets, but by most measures, it achieves poorer results than European counterparts. A major reason is that the 5 percent of Medicare patients who die every year consume almost one-third of all Medicare expenditures. And one-third of those costs are incurred in the final month of life, when there is no chance of a real recovery.

The number of Americans 65 and older will double in the next 20 years, putting more pressure on our medical system. People understandably worry that treatments that could benefit them may be less accessible, but the enormous amount of money paid to extend suffering at the end of life benefits no one.

Today 75 percent of Americans could die comfortably at home with hospice care. But we have to make that choice personally, talk frankly with doctors and family — and work to change family and community attitudes.

All we need is the will.

Complete Article HERE!

Let’s talk about dying

Lillian Rubin lives and works in San Francisco. She is an internationally known writer and lecturer, who has published twelve books over the last three decades. Last evening her latest essay appeared in Salon. It’s brilliant and a must read.  This courageous woman breaks open a discussion we are all literally dying to have. But so much in popular culture avoids and even prohibits this essential death talk. I commend Lillian for breaking this cultural taboo. Perhaps now others in the media will do likewise.

Lillian Rubin

Complete Article HERE!