What to Expect With End-Stage Heart Failure

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End-stage heart failure is the most advanced stage of congestive heart failure. At this point, treatments don’t offer too much symptom relief.

There are four stages of heart failure. The first two stages—A and B—are considered pre-heart failure, where lifestyle changes and medications can largely keep the condition at bay. By stage C, you may have symptoms like swollen limbs, fatigue, and shortness of breath with physical activity.

By stage D, the heart has experienced significant damage, and it has begun to affect how other organs work, like the kidneys. Treatment for this stage includes surgery, heart transplant, or ventricular assist devices. You may also pursue hospice care—treatment based on comfort alone.

Signs

Congestive heart failure is usually thought to be a condition of the heart, but it can affect other organs as it progresses. It continues to get worse with each flare-up, or exacerbation, and 90% of people with the condition eventually die of pump failure.1 This is when the heart can no longer function as a pump, and circulation of blood and oxygen through the body stops.

Symptoms of end-stage heart failure stem from this deterioration of the heart’s pumping power. As the heart grows weaker, it can’t pump enough blood to other parts of the body, and blood and fluids begin to back up.

Tissues and organs that don’t receive enough blood, oxygen, and nutrients fail to work effectively. The symptoms of end-stage heart failure are caused by the body’s attempt to compensate for a weakened heart.

Symptoms of end-stage heart failure are similar to those in stage C, only they are more severe. They may include:2

  • Swelling and fluid collection under the skin
  • Shortness of breath, even at rest
  • Pulmonary edema, where excess fluid fills the lungs’ air sacs
  • Weakness and fatigue, especially with physical activities
  • Low blood pressure
  • Malnutrition, or failure of your body to absorb nutrients
  • Sudden weight gain
  • Increased nighttime urination

Coping

As your end-stage heart failure progresses, it will become more difficult to perform routine daily activities like bathing or walking through your house. You may require home care, a move to a skilled nursing facility, or frequent or continued hospitalization.

At advanced stages, you may need to be hospitalized for intravenous medications, oxygen therapy, or other treatments. If you don’t improve with hospitalization or need skilled nursing care, your medical team may recommend hospice or palliative care:

  • Palliative care: Contrary to what many people believe, palliative care is not necessarily end-of-life care. Palliative care focuses on relieving symptoms and discomfort caused by a chronic illness. Treatments continue with palliative care in many cases, but there is a greater focus on improving the quality of life. In people with heart failure, a palliative care visit during a hospital stay for heart failure was linked to decreased future hospital stays and intensive care unit admissions, and fewer aggressive treatments.3
  • Hospice care: Hospice care also focuses on comfort and quality of life, but you also make the decision with hospice care to forgo additional invasive or lifesaving measures.

Prognosis

Only about half of the people who have heart failure that’s in stage C or beyond live for five years after their diagnosis.3 More than a third of people with advanced heart failure die within a year of being hospitalized.

People who receive heart transplants or a ventricular assist device, which can help the heart pump out blood as it grows weaker, have a better outlook. While life expectancy on a ventricular assist device is limited, people can often expect to live 10 years or more after a successful cardiac transplant procedure.1

The American Heart Association (AHA) supports frequent conversations between you and your medical team in end-stage heart failure. Shared decision making is a partnership between you and your doctor where you openly and regularly discuss your condition, treatment options, and prognosis.

To help with the shared decision-making process, AHA offers the following checklist:4

  • Annual review of your condition and progress, current treatment goals, and plans to address emergencies and worsening of your condition
  • Review of treatment goals after “milestone” acute events like a hospitalization, heart attack, or need for defibrillator shock
  • Open and honest conversations about the side effects and quality of life impact that different treatments or worsening of symptoms may cause
  • Discussions about the impact of your condition and treatment options on you and your caregivers or family
  • Palliative care alongside medical treatment to help manage symptoms
  • Hospice care or other end-of-life planning to make sure your wishes are met when your condition advances

What Does Moving to Hospice Care Involve?

If you and your family have made the decision to pursue hospice care while receiving inpatient care, a case manager or social worker can help facilitate the process. If you are at home and would like to transition to hospice care, hospice agencies can help make the arrangements. Hospice agencies will review your needs and have a doctor order the appropriate medications for you. These medications will focus not on treating your condition, but on managing your symptoms and comfort as much as possible.

Caregiver Support

Supporting and caring for family and friends with end-stage heart failure can be difficult. At advanced heart failure stages, a person with this condition will need help with their daily activities.

Coping with the demands of caregiving can be difficult. If you are a caregiver, enlist the help of others, and involve your own healthcare providers in creating a plan that keeps your health and well-being in mind. There are services that can offer respite care, or temporary medical care for the people you care for when you need a break.

Palliative and hospice care can help caregivers cope as their loved one’s condition deteriorates, and they can find ways to make them comfortable as much as possible. The American Heart Association also recommends that caregivers find support groups in their community or online.5

Frequently Asked Questions

What is end-stage heart failure?

End-stage heart failure is the most advanced stage of heart failure. At this stage, medications and treatments can no longer improve the symptoms or prognosis. The focus of treatment at this stage will be to manage your symptoms as best as you can and prioritize comfort.

What are the signs of end-stage heart failure?

In end-stage heart failure, you may experience severe shortness of breath, swelling, and fatigue. It may become difficult to live independently and meet your own daily needs.

What should I expect at end-stage heart failure?

In end-stage heart failure, you may need frequent hospitalizations, and each acute event may make your condition worse. Your healthcare team may suggest skilled nursing, palliative, or hospice care to help you manage your condition.

How long can you live with end-stage heart failure?

Heart failure is a chronic, progressive condition that worsens with each flare-up. Your outlook and prognosis are better if you are healthy overall, you have been following your treatment plan, and you are responding well to your treatments. Being willing to pursue invasive treatments like a heart transplant will also increase your life expectancy.

Summary

End-stage heart failure is the most advanced form of heart failure, where your heart cannot pump blood effectively to meet your body’s needs. Treatments that have helped you manage earlier stages of the disease may not work anymore, and your healthcare provider will prioritize alleviating the discomfort of your symptoms. It’s still important to stay healthy because that could potentially improve your prognosis.
Continue reading “What to Expect With End-Stage Heart Failure”

The Dignified Exit

The Inevitable: Dispatches on the Right to Die

By Elena Saavedra Buckley

AS MEDICAL AND technological advances have made our world safer, it’s become much harder to kill oneself painlessly, even if one intends to. Asphyxiation by carbon monoxide, usually done by inhaling car exhaust in an enclosed garage, has gotten harder as the automobile industry’s emissions levels lower over time. Ovens have followed a similar trend, with natural gas models outplacing those that run on coal. The shift is especially true when it comes to medications. Use of Nembutal, the barbiturate that killed Marilyn Monroe, declined in the second half of the 20th century and was eventually discontinued in the United States, leaving available fewer substances that can cause a nonviolent overdose. (Other lethal medications have multiplied in price, sometimes threefold or more.) For those who desire “rational” suicide — done after consideration rather than, as is more typical, spontaneous despair — options are limited outside uncertain and gory methods. We live more protected lives than we once did, but, in exchange, the ability to end our lives peacefully is kept out of reach, like a bottle of recalled pills.

The subjects in Katie Engelhart’s essential, vulnerable book, The Inevitable: Dispatches on the Right to Die, question these barriers. Since the mid-20th century, conversations on assisted suicide have grown, as laws allowing it have passed around the world. In popular conversation, Engelhart writes, people who use assisted death usually fit an archetype: elderly, secular, white people, with terminal diseases and supportive families, take advantage of rare right-to-die laws soon before their likely natural death. They throw back a lethal cocktail of liquid drugs under the watch of a doctor and their loved ones. They fall asleep, and, within a few hours, their heart stops. “While most reporting about the so-called right to die ends at the margins of the law, there are other stories playing out beyond them,” Engelhart writes. “Didn’t I know that whenever the law falls short, people find a way?”

Engelhart, a former reporter for VICE and NBC News, profiles two rogue doctors and four subjects who seek assisted death in a variety of illicit shades: an elderly British woman who feels she has lived the life she wants; an American woman in her 30s with worsening multiple sclerosis; an American woman sinking into dementia’s abyss; and a 25-year-old Canadian man with complicated, severe depression. Engelhart profiles them as they either seek help with suicide, through mail-order chemicals or services overseas, or challenge the limits of their country’s laws. Engelhart is ever thoughtful; the approach can fall flat during meetings with secondary doctors or interviews with philosophers (summoning more than one description of office shelving), but Engelhart’s main portraits, and her careful relationships with her subjects, powerfully animate her central questions: what is dignity, and what does it mean to die with it?

As she chases dignity’s meaning, Engelhart meets early dead ends. Some of her interviewees brush off the question, saying that dignity amounts to feeling respected, making their own choices, and, mostly, being able to wipe their own asses. (“When someone has to change my diaper, I don’t want to live.”) But if dignity can be understood at an individual level, it is twisted by the systemic factors Engelhart describes that lead to death wishes: the specter of melancholic senior living facilities, unsuccessful mental health treatments, and impossibly expensive health care. The Inevitable is international in scope, but these pressures loom largest in the American medical system. When visiting Brussels, Belgium, Engelhart speaks to Wim Distelmans, an oncologist and euthanasia proponent, about whether assisted death should be offered to more people in the United States. “It’s a developing country,” he tells her. “You shouldn’t try to implement a law of euthanasia in countries where there is no basic healthcare.” A reader wonders, then, what it means to assert dignity within circumstances that do not do the same.

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Voluntary euthanasia may appear in Thomas More’s vision of Utopia, but doctors have long struggled to write it into their job descriptions. In 1995, the American Medical Association stated that “[p]hysician-assisted suicide is fundamentally incompatible with the physician’s role as healer,” and the National Hospice and Palliative Care Organization opposes the practice. The membrane between palliative care and assisted suicide is thin, though — in some cases, tending to fading life with pain-relieving drugs functions as a kind of assisted death, albeit a slow one. Engelhart roots this dissonance in the 20th century’s effort “to conceptually transform old age from a natural phase of life into a stage of disease,” she writes, “and, by extension, something to be defeated, rather than embodied or endured.”

Assisted suicide has been legal in Switzerland since 1940, and some other European countries, like Belgium, have allowed it since the 1990s. (Parts of Australia and Canada allow it, too.) Its American history is piecemeal. As health-care prices climbed sharply in the 1970s and ’80s, a string of high-profile cases of young white women on life support drummed up public conversation. Then, in 1994, Oregon became the first state to legalize assisted death. Other states followed Oregon’s strict parameters: a patient must be terminally ill and have six months or less to live, and they must have the mental capacity to make the decision, as determined by a doctor. On their chosen deathbed, a doctor will give them the lethal barbiturate, but they must lift it to their own mouth in a final, performative gesture of agency.

Opponents of assisted death have long argued that the practice will fall down a slippery slope of exploitation. Poor patients and the elderly, critics say, will feel pressured to die rather than rack up medical costs for their families. People with depression will choose it over trying more treatments. Historically, voluntary euthanasia and eugenics attract similar supporters, and today, some disability rights groups warn that the practices are “fatally tangled.” (One doctor Engelhart speaks with wants to create machines that can provide assisted death more easily than drugs; he sheepishly describes one of his coffin-like prototypes as “a little Auschwitzy.”) So far, though, there is no evidence from Oregon or other states that the laws have caused disproportionate deaths in any demographics. In fact, the opposite might be true. Engelhart spoke to doctors who knew of patients who qualified under the laws, and who wanted to die, but who could not afford the drugs. “Poor patients sometimes had to live,” she writes, “while richer patients got to die.”

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Like much great narrative journalism, The Inevitable powerfully justifies its form when mapping how people relate to each other outside dominant systems — in this case, how end-of-life care can exist away from, or in opposition to, big medicine. Beyond trickster doctors like Jack Kevorkian — the American pathologist, dubbed “Doctor Death,” who in the 1990s turned assisting suicides into a kind of civil disobedience — barely underground networks have offered assisted death to people who don’t meet the law’s eligibility. One of Engelhart’s subjects, Debra, is a widow in Oregon who does not want to fully succumb to her dementia. She ends her life before that happens with the help of the Final Exit Network, a group of volunteers who instruct the elderly on how to commit suicide and accompany them through it. When she is ready, two volunteers arrive at her house, hug her, and kneel next to her wheelchair while she uses a plastic bag and gas canister to stop her own breathing. Even with its analog methods, this moment feels dignified, closer to what care should look like — especially when put into relief by the police who show up to her door some hours later.

Other narratives are murkier. A woman named Maia, the only main subject from the book who is still alive, speaks with Engelhart while working through the decision to schedule her death at a clinic in Basel, Switzerland, seeking relief from multiple sclerosis. Maia is slowly and painfully approaching paralysis. “I believe the soul travels on and wants to be free from this prison that has become my body,” she wrote in her application to the clinic. Maia felt early, undiagnosed symptoms of her MS in her 20s, but, following the advice of her father, she hoped for the best and declined treatment. Once the debilitation became obvious, she wondered whether those early treatments would have prevented the disease’s severe progression. The future she is left with will require constant assistance and treatments. In the United States, it will send her into poverty. (She unsuccessfully attempts the most American of options: a GoFundMe for medical expenses.) Maia is sure of her plan, but she seems consumed by wondering whether she could have lived a different life or whether she has suffered enough to end the one she has. Even with her Swiss appointment, she closely follows right-to-die bills in the United States. “On an idealistic level,” she tells Engelhart, “I’m obsessed with dying in my own country.”

For Maia, it seems, dying in the United States would be a kind of acknowledgment, an agreement that her country shares responsibility for her distress. The Inevitable is interested in dignity and how people define it, but it does not ask so explicitly whether the state, and the laws it creates, can recognize people’s dignity in the first place. If our systems of governance fail to care for so many — and kill others on death row and in the streets — can they be trusted to control the choice to die? If a “developing country” without universal health care did offer wide access to assisted death, one wonders whether its use could make that country’s ills more obvious, more urgent, less ignorable. When The Inevitable snaps back to the perspectives of its individual subjects, the implications of these political threads can get lost; the perspectives of nonwhite patients, or people who harbor more doubt in the medical system from the get-go, are also mostly absent from the narrative. Still, the book’s brilliance is in how much fertile ground it lays for these questions.

Near the end of The Inevitable, Engelhart profiles Philip Nitschke, an Australian doctor who has become one of the most vocal supporters of the unrestricted right to die. Nitschke founded Exit International, another organization like Final Exit Network. His is far more boundless than others; they sell The Peaceful Pill Handbook (2006) to almost anyone with instructions for safe suicide methods, and Nitschke gives public “DIY death seminars” with his wife’s help. He is at the radical end of the book’s spectrum, yet after the rigid patterns of death barely evaded by Engelhart’s subjects, his beliefs appear risky but benevolently imaginative.

When Nitschke started his career, he only accepted assisted death on a limited scale. But as he met the kind of people who could be in The Inevitable: Dispatches on the Right to Die — a taxi driver with stomach cancer, for one, who died painfully without the legal right to die — these limits dissolved rapidly. What did age have to do with it, really? And, more than that, if physical pain was an acceptable reason to end one’s life, shouldn’t mental pain be, too? Doctors and lawmakers, he came to believe, couldn’t pick and choose. There was simply too much gray area. “Philip came to think that efforts to suppress rational suicide were ‘a sign of an increasingly sick society,’” Katie Engelhart writes. “They were a sign that, maybe, society wasn’t so confident in its reasons for insisting on life.”

Complete Article HERE!

The Books Keeping Me Grounded as I Contemplate Becoming a Care Partner to My Parents

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My mother was driving home from work one drizzly day at the end of 2019 when she was struck by an oncoming car that had veered into her lane. Her car was totaled but, luckily, she sustained minimal injuries. Still, she was mere months away from retirement and, now, she had to grapple with the effects of a concussion, shoulder pain, and severe anxiety.

It was eventually determined that she would need surgery for her shoulder. But then the pandemic hit and her treatment was delayed.

A year and a half later, she still has shoulder pain and tires easily. She goes to physical therapy three times a week. Sometimes, she has flare-ups and needs cortisone shots. She’s nervous about driving very far.

My father, meanwhile, has been wrestling with chronic depression and anxiety for years (we two are birds of a feather…). In recent years, his hands have developed tremors that have become increasingly worse. Testing has revealed inadequate answers.

Amidst other medical issues, it also emerged that my father was experiencing memory problems. The other month, he was diagnosed with mild cognitive impairment which, in 50% of cases, can grow into full-blown dementia.

I’ve had an interest in end-of-life care for a while now, mostly because of what I observed when my mom was caring for her own father. I’ve written previously about the books I’ve enjoyed that tackle end-of-life care, compassion fatigue, and caregiver burnout. More recently, the topic has become a side niche for me in my journalism work. In a piece that went live on Rewire.org last month, I write about the lack of systemic support for unpaid family caregivers.

All this time, I felt I was preparing for something. After all, I’m 40. My parents are 70.

But as the past two years have brought more challenges — both with their health and with the decisions I was forced to make for my 6-year-old as COVID spread across the world — I realized I wasn’t prepared at all.

So, I turned to books. Because of course I did. That’s what I do. And while I’m still scared of the inevitable shift to come in the next few years, I at least feel more grounded in what it all means, and what options we have.

If you, too, are entering the “sandwich generation,” allow me to share which books were helpful for me.

Being Mortal by Atul Gawande

I actually read this one several years ago, but I’ve found it to be a good one to return to. In it, Gawande contemplates what it means to experience a “good death,” and shows how medical advances have led us to push back against the bounds of mortality in such a way our quality of life in later years is adversely impacted. He then shows that there is another way and that, rather than postponing death, we can enjoy life — until the very end.

Advice for Future Corpses (and Those Who Love Them) by Sallie Tisdale

A fellow Book Rioter recommended this one to me back when I first started to get nervous about my parents’ health. After reading a library copy, I ordered my own copy, and now I’m doing a reread so I can dog-ear pages and take notes. Every time my husband sees the book on the counter, he shakes his head and calls me a morbid weirdo. But this book is a revelation. Written by a practicing Buddhist who also spent a decade working as a nurse in the field of palliative care, Tisdale provides a comforting perspective on whether or not a “good death” actually exists (good for whom?); what you should and should not do, say, and expect from your loved ones in their later years; what you can expect at the different stages of aging; the nature of grief; and more. I may be a morbid weirdo, but at least I’m a morbid weirdo who now feels a little less afraid.

Can’t We Talk About Something More Pleasant? by Roz Chast

I actually ready this one right before my dad received his MCI diagnosis, and I felt as if I were looking into my future. There is the anxious, aging father who eventually slips into dementia. There is the willful, stubborn-as-fuck, aging mother who refuses to ask for help when she needs it. And then there is the daughter — Roz Chast herself — who doesn’t know quite how to handle this sudden shift without completely upending her own life. Beyond the parallels to my own life, I appreciated how this graphic memoir showed a woman pushing back against what is expected of daughters, making decisions that took into account not only the care of her parents but also of herself. Foregoing one’s own care is a trap many unpaid family caregivers fall into.

What We Carry by Maya Shanbhag Lang

My mom and I have always been close…in a slightly codependent way. So I immediately connected to Lang as she described the ways in which she needed her mother — how much she counted on her to be there and support her during hard times — and how disoriented she became when, after becoming a mother herself, things changed. There are a lot of layers to this memoir, but what felt particularly relevant to me were the moments of reflection around her changing relationship to her mother as her mom became swallowed up by Alzheimer’s and the way this informed how she mothered her own daughter. On top of that, threaded throughout the book, was a fable of sorts about a woman who carries her child across a river and, as the waters rise, must decide whether to save herself or her child. By the end, though, Lang begins to see that the question of who to save is not as black and white as it first appeared.

Complete Article HERE!

What is right to die?

‘The End’ central character depicts reality of dying with dignity

Harriet Walter as Edie and Frances O’Connor as Kate in ‘The End’

The End’ talks about euthanasia and why it might be really important for people who want to die with dignity

By Aayush Sharma

‘The End’ is an Australian TV series that talks about euthanasia, gender identity and more in a quirky manner. It follows three generations of a family trying to navigate through life while facing obstacles at different points of their lives. The show mainly focuses on Edie (Harriet Walter), a woman who has lived the last decade in complete misery and doesn’t want to live anymore. On the other hand, her daughter, Kate (Frances O’Connor), is a doctor in Australia who specializes in palliative care.

Edie hasn’t seen her grandchildren in many years and believes that she doesn’t have any will to live now. She is one of those who advocate ‘euthanasia’. According to her, everyone should be allowed to die when they feel like they can’t take it anymore.

The most important aspect of the story is that it is not superficial at all. It is based on real-life experiences where we have seen people fighting for euthanasia and demanding that they should be allowed to decide when they want to end their life.

Harriet Walter and Frances O’Connor in ‘The End’

What is right to die and why Edie wants to end her life?

‘Right to Die’ is a concept based on the opinion that human beings are entitled to end their life or undergo voluntary euthanasia. Voluntary euthanasia is conducted with consent. It is understood that a person with a terminal illness, incurable pain, or without the will to continue living, should be allowed to end their own life by using assisted suicide or to decline life-prolonging treatment.

However, there is always a debate as to who is empowered enough to assist in such matters. Showrunner Samantha Strauss has worked beautifully to portray this issue in a quirky manner. The show mainly follows Edie (Harriet Walter) trying to end her own life. When a log rolls from the fireplace and prematurely sets her house ablaze, Edie decides to jump from her house’s window and end everything. However, Edie survives and suffers injury on her left arm. She believes that if someone is competent to decide, nobody other than that patient should have the authority to decide whether life is worth continuing.

Belinda Teh Walks from Kings Park to the WA Parliament with Euthanasia advocates on August 6, 2019, in Perth, Australia

The attempt forces her daughter to move her mother from England to Australia to keep an eye on her. During one of the scenes, we get to know that she is a survivor of breast cancer and she has also had a double mastectomy. As soon as she is relocated to a retirement village in Australia, we get to know that there are many who want to die with dignity and not suffer in pain.

This is the entire crux of the situation: the right to die with dignity. In one of the scenes, a character on the show blames the hospitals for making people like them “cash cows”. He also says that the hospitals put them in misery so that they can make money out of it.

Youssef Cohen, 68, sits while undergoing cancer treatment as his wife Lindsay Wright looks on, on March 17, 2016, in New York City

The decision about whether to continue living in such conditions is among the most important that can be made. Many patients in a persistent vegetative state or else in chronic illness, do not want to be a burden on their family members.

Furthermore, the right to die with dignity is not an ordinary law. It is not a right granted to someone to kill, but it should be seen as an option for a conscious and free person to be understood and helped in a special request that is to end his or her life.

As far as the show is concerned, the idea of euthanasia is something that you would feel conflicted about. However, to Edie, it doesn’t. She feels that rather than going to a retirement village and die while being in suffering would be much worse than taking her own when she knows that it is time. This is not something that most people will understand, but as you watch the show you’ll also realize that it tackles the issue of the right to live as well. When Edie is confident that she wants to end her life, in the process, she also gets to know why living is important.

Let’s just say that ‘The End’ might be one of the most important shows of our times and tells the world about people in suffering.

‘The End’ premieres exclusively on Showtime on Sunday at 8 pm ET.

Complete Article HERE!

What happens when someone is dying?

Dying is unpredictable. It is not always possible to know for sure that a person is in the last days of life, predict exactly when a person will die, or know exactly what changes the person you are caring for will experience when they are dying.

However, there are certain bodily changes that show a person is likely to be close to death. It is normal for these signs to come and go over a period of days, and if they do go, this does not usually mean that the person is recovering.

Some of these changes may be distressing, but it can be reassuring to know what to expect and how to help. Signs that a person may be dying can include:

By clicking on the links above you can find out more about these changes and whether there is anything you can do to help.

The links below give more information and practical advice relating to other concerns or questions that might arise:

More information about support available and what to do after a death is available at the links below:

Thanks to the National Council for Palliative Care, Sue Ryder and Hospice UK for their kind permission to reproduce content from their publication What to expect when someone important to you is dying, which can be downloaded or purchased from the Hospice UK website.

Complete Article HERE!

Scientists Monitored 631 People As They Died.

This Is What They Found

The largest international study of the physiology of death to date shows that death is “more of a continuum than the flipping of a switch.”

By Eleanor Cummins

The living have always worried about the dead coming back to life. It’s the plot of the New Testament, the reason 19th century families installed bells in their loved one’s coffins, and a source of tension in end-of-life care today.

While doctors work to reassure families holding vigil in intensive care units and hospice facilities that the end has indeed come, death remains something of a mystery—even among medical researchers. 

These unresolved questions around things like brain death, cardiac death, and more have led to the proliferation of “myths and misinformation,” said Sonny Dhanani, chief of pediatric intensive care at the Children’s Hospital of Eastern Ontario. 

“We felt [stories about the dead coming back to life] might have been impacting people’s motivation to consent for their loved one to be a donor, and for the medical community to offer, donations,” he said. “We wanted to provide scientific evidence to inform the medical understanding of dying.”

In a new study, published Thursday in the New England Journal of Medicine, Dhanani and his team report the results of the largest international study into the physiology of dying to date. It suggests the living can rest easy, kind of.

Between 2014 and 2018, the researchers observed the heart function of 631 patients in 20 adult intensive care units in Canada, the Czech Republic, and the Netherlands after they were taken off life support. The scientists found that 14 percent of the dead showed some flicker of cardiac activity—measured by the electrical activity of the heart and blood pressure—after a period of pulselessness.

But the doctors at the patient’s bedside never got a determination of death wrong. “No one lived. Everyone died. No one actually came back to life,” Dhanani said.

The sputtering was short-lived—the furthest cardiac activity came just 4 minutes and 20 seconds after their heart initially stopped beating—and not strong enough to support other organs, like the brain. 

The data “help us understand how to medically define death, which is more of a continuum than the flipping of a switch,” according to Joanna Lee Hart, a pulmonary and critical care physician and assistant professor at the University of Pennsylvania’s Perelman School of Medicine.

“Our bodies are physiologically designed to stay alive… As our bodies try to keep us alive, they will pump out natural chemicals to sustain life as long as possible,” Hart wrote in an email to Motherboard. But, she added, “Once the dying process starts, it is very hard to return a person’s body back to a condition where the person can survive.”

This should be comforting to families and medical providers. Among other things, the research affirms that current practices, which typically tell doctors to wait 5 minutes after the pulse stops to name a time of death, are working. At that point, things like organ retrieval are safe to start.

While there are still plenty of questions about death, dying, and the afterlife, this study—which is unlikely ever to be repeated, given its scope—is something close to the definitive word on the question of the post-mortem cardiac activity.

“Determining death is so emotional to everyone,” Dhanani said. “We hope that rigorously studying death and dying, not being afraid of that conversation, will help.”

Complete Article HERE!

Planning for death can bring peace of mind

By: Cynthia Breadner

“All that lives must die, passing through nature to eternity.”
William Shakespeare, Hamlet, Act 1, Scene 2

Today is a day of earned celebration as Italy takes home the cup for their big win playing soccer, or as it is called elsewhere “football”. As I watch the news recounting the celebrations, it is with joy I watched people together in community with a common goal to be celebrating and sharing the love of a sport or activity. Being alone, or solo is not how we are meant to be. We are social beings and in the animal kingdom, this is evident when all things gather.

That said, as the pandemic has continued, our ability to watch or stream online programming at home offers so much entertainment people may not notice they are alone! One can feel they have friends when watching three, four, five, or even 10 seasons of a program all in one swoop. The characters become your friends. I remember a fantasy movie from my childhood or youth, where a person is standing before a wall of screens and has a script in their hand. They are an actor in a drama from their own living room. That is all I remember and if anyone can identify this drama, I would love to know the name of it. Regardless of that, our choices of entertainment with the addition of NetFlix, Amazon Prime, CTV streaming, GlobalTV streaming, and CBC GEM no one can say they are bored. The world is one’s oyster searching for that pearl of enjoyment. Is this good? I am unsure. Entertaining, yes! Good? My jury is still out.

One of the downsides to so much viewing entertainment, I find my body is stiff. My back and sit muscles sometimes feel the stress of sitting in one place for too long. Evidence that I watch too much! However, I wonder what else can I do in a time where we are constantly threatened and reminded to keep our distance. It seems we are pushed into a solitary life. The chair where I sit has become my friend and my place of comfort and a companion that feels safe and easy. This action in my life is a reminder of when my mom died, and we cleaned out the house where she had lived for over 40 years. I took the sofa she had purchased recently for my own new apartment. I had lived in one room with a bed, out of my car, and transient for a few years going to school and ended it with staying with her in my childhood home, providing companionship and care. In the fall of 2009, I was heading to Toronto to begin the Masters program and as a family, we decided to prepare mom for a move into formal care in the fall when I moved to the city. I was 50 years old that summer and, with grown adult children, was quite alone in the world. As the youngest child of my mother, I was the only one able to live with her and not leave others alone at home. My self-discovery in this journey was huge.

I discovered how much my mother depended on the television as her entertainment and this was pre-streaming, pre-NefFlix, pre-online. She had a satellite dish so was blessed with many choices, yet she always landed on the same programs. The couch I sat on in my new apartment always transported me back to the vision of her perched on the edge watching her “story” (The Young and the Restless), ready at a commercial, to fly out of the room and peel the potatoes or stir the soup. This newer sofa replaced one that had broken down in the one spot where she sat. This new sofa had the indent of her bottom ever so lightly that it gave me comfort. I could believe her spirit was sitting there making this indent long after she was gone. Little did I realize how much I would miss her when she was gone. I was warned. A warning I did not take to heart. I ignored it and guffawed at the possibility I would never miss my mother, I said, rolling my eyes. That said, after her death and 12 years later I still miss her so much.

This sofa represented her alone time after dad died. It also represented the years before he died. The times where she felt so guilty watching TV when she thought she should be busy with something else. The hours she watched and enjoyed this new type of entertainment that came to her later in life. Mom and dad did not even have a television until the late ’50s and so for her, it was still a novel idea and something new! As I looked at the sofa now in my living room I could return to my vision of her perched on the sofa watching her favourite programs. On the 26” floor model console along with her story, she watched Wheel of Fortune and Jeopardy. She caught up on the news and her favourite in later years was Reba and Everybody Loves Raymond. I can remember and see her watching The Price is Right every morning from 11 – noon and just when the winner of the showcase was announced she would jump up and fly out to the transistor radio on the kitchen counter and turn it on to hear the funeral announcements from CFOS in Owen Sound. If there were any, they would be announced precisely at 11:56 a.m. right before the noon news. Her timing was impeccable, and her routine was solid. As she listened dad would slide open the patio screen door or push open the sticky wooden door coming from the “back” kitchen, home for lunch from the apple orchard. He would hang his hat on the same peg, sit in the same chair, and lunch prayers would be said over a sandwich and a coffee.

We moved to the house in Heathcote in 1970 when I was 11 years old. My mom and dad both died while living there. Mom’s last days were the same routine even though she could no longer jet from the television room to the radio she still managed to time it right, so she never missed the funeral announcements. She would push her walker out to the kitchen during the last commercial break at about 11:45 of The Price is Right, return and watch the end of her show, then as the music started indicating the announcements, she would push her walker back out to the kitchen and listen as she slowly walked. I often wondered if she pined to hear her own name to escape the loneliness. Both she and dad died in LTC very shortly after leaving this home. My dad died within three or four months of moving and mom was only officially there for three weeks. While mom was able to watch her favourite programs in her last days, she did so while staring out the window into a parking lot, sharing a room with a stranger. They stayed in their home for as long as we thought possible. I see now with what I know, they could have both stayed at home longer if I knew then what I know now.

As I watch my own favourite programs and sit in the quiet of my solitary life, and I wonder what my third trimester will look like. I feel closer to my parents and my older siblings as we all age. Fear sets in as I interact in LTC with all the aging and watch their lives in our current care pattern. Each and every person has my mother’s face and I spend quality time caring for them with a gentle voice and a song if they cannot talk to me, I sing to them. I wonder what care will look like in 25 years when I need it. What I do know is something must change, I am just not sure how to change it. How do you turn the Titanic? We all know that story and our elder care system is the Titanic, quietly cruising in the dark, straight towards disaster because no one knows how to fix it. I do my part staying the course and will go down with the ship, because this ship will go down, taking the frail, the elderly, and the delirious with it.

To not leave this pondering in such a dark place I want to offer some hope. Hope begins with the family unit. How does one die at home? With planning and care. With a community of care and conversation. I was afraid and I was angry when my parents needed me. I thought my life was more important than their last few years. I wish now I had given what was needed to make their last days as beautiful as I could. That said, I want to help others plan for end of life. As we plan for the birth of a baby with joy and beauty, we can do the same for the birth of a soul into the next life. Letting go and the best care possible is at hand. The current system is broken, so be the change you want to see in the world, begin now to plan for your own end of life, and talk with your aging loved ones about what to do when their time comes. If I can do nothing else but bring awareness to choose education and passion around end-of-life care I will be happy. There is always a choice, and good planning for a good death brings joy and peace in the years to come. As the next few years of an aging population who will be demanding and more financially prepared than ever before, let’s work together to make a good death possible. It is not “if” we die it is “when” we die, and embracing death as the next adventure and heading there with acceptance and joy is how life can be lived fully. Our lives are a program that will be in reruns in the memories of those who knew us. When they watch will they watch with love or regret? Be the director of your own movie and make it a love story to be remembered and have people watch it so often they leave a dent in the couch where their bum has been.

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