living your best to the end

Death and doctors who don’t want to talk about it

What happens when patients want to talk about death, but their doctors don’t? My 94 year-old father-in-law was relieved and delighted when I brought forth the subject of medical directions, in the event he couldn’t speak for himself. My brother in law – a paramedic – brought a standard Do Not Resuscitate (DNR) form. Although written in largely incomprehensible language for a mere non health care professional, I took it upon myself to discuss more than just the decision to resuscitate – shocking his heart back to life. He was right on board with ‘no heroic measures’ – and even more adamant when he understood what ‘heroic’ and ‘measures’ meant in the context of his quality of life.This form required signature from a doctor, so he brought it to his next regular visit to his long-time family doctor. His doctor was aghast. “Who put you up to this? I’m not going to sign this. I don’t think this is what you’d want.” What?! Not an isolated incident, as I’ve discovered. I’ve been conducting informal interviews with healthcare professionals of all stripes about their reaction to not initiating or discontinuing life-prolonging interventions. This includes supplemental feeding (Feeding Tubes) breathing (ventilators and tracheostomies) and dialysis. It’s as if you’ve asked them to condone murder. It’s as if you’ve asked them what they’d want for themselves.. Often these are the same healthcare professionals who purport to want to follow patients wishes, but who try to talk their patients out of their wishes. “If I do that, you know what it will lead to.” Well, yes. It’ll lead to the death, but possibly...

Grief and relief: tradition, culture and religion

In this fast-forward world, it can seem that grief should have a ‘best before’ date. It can be uncomfortable – for those grieving and those around. Grief can also be exhausting and stressful and relentless. Considering few of us are spared the knife-cut that comes with the sorrow of loss, there are time-honoured rituals and traditions that help on the road to softening suffering. Christian For Christians, a wake includes visitation – seeing the body – and, after the funteral, gathering to pray for and celebrate the life of the deceased. From: The Light Beyond Jewish In the Jewish tradition “Sitting Shiva’ is 7 days of mourning during which time the bereaved is (are) never alone: Our sages allocate days one through three for crying, and days four through seven for eulogizing. After that, one does not mourn excessively, but follows a grieving process that gradually diminishes. Ideally all of the direct mourners sit shiva in the house of the deceased, for it says, “Where a person lived, there does his spirit continue to dwell.” Thus the presence of the person who has passed away is strongest in his own home From: Chabad.org Indigenous There are  many pre-death rituals to help the the dying on their journey and also to help those left behind:. It was very touching to see that at the end of the funeral where the burial.. the sun dance drum ent to sing that last song for her. I’ts calld the Traveller’s SSong.. it’s a beautifl son, a beautiful song and it’s her journey back to the spirit world I think [that kind of ]...

Medical jargon: even single-syllable words can confound

Who’d’ve thought that simple, one and two-syllable words – which is one of the the criteria for Grade 6 reading level – could cause so much confusion, upset and medication errors. Out of context, even every-day words can confound. Consider these (true) examples: In a maternity unit, expectant mom is thirsty and hungry. When she asked if she could eat or drink anything, nurse, hurrying to the next patient, answered, “only sips and chips.” Later, same nurse saw, with horror, mom eating potato chips, taking sips of a diet soda. To that mom-to-be, those one syllable words didn’t say sips of water and ice chips. Seeing his patient in the wrong hospital unit, Doc says, and patient hears: “We’re going to get you to a different floor.” After doc leaves, worried patient says to nurse, “The floors are so cold. Will I have a blanket on the other floor?” Son, taking his elderly mom to the doctor to have her rash checked out. First visit, no source was identified. Second visit, doctor said rash was static. Until the third visit, 3 months later, when doctor said the words: “the condition of the rash hasn’t changed”, the son had tried to find a fabric softener that’d reduce static in mom’s clothes. Early evening, as I was leaving an office building, one of cleaners in the elevator with me sighed so mournfully I asked if she was ok. “My husband is going for by-pass tomorrow. Last year, the doctor told him to take coated Asprin©. We didn’t understand coated, so he didn’t take it. Now he’s in the hospital.” (Note this...

BestEndings Flash Video Chat: Talking about dying

Impromptu End of Life conversation captured on video It started out as an experiment: there was a new video camera, an excuse to get together with a good friend who ‘does the lighting’ for movies and commercials. He makes everything look beautiful. And why not get in pizza and invite some friends, and get a proper lighting lesson and camera test. Pizza topping had to take into account various cultures: Hindu, Muslim, Mexican-Catholic, Irish-Catholic, Anglican. Chowing down, the ‘what’re you up to’s’ led to my continued interest in all things related to end of life. Sparked quite a convo! And so a purpose was found and a flash video chat created. The result was too good not to post. The question I posed: “Why is it so hard to talk about dying.”   Starring: Mike Houlahan , Sudhir and Ruth Handa, Colleen Young, Georgina Camacho Ibarra and Majid Ariannejad It’s 12 minutes long, broken into 5 parts. Watch each separately, or ‘play all’ Part 1: End of life conversations are not an easy for Mike and his Dad, even tho they consider themselves ‘intelligent and caring men.’ Collen is not afraid of talking about dying and death, and knows her mother’s wishes for a ‘good death. Part 2: Ruth shares thoughts and insights on why many find it hard to talk about dying, end of life and death. Fellow BestEndings chat-ers identify with what she’s saying.   Part 3: Majid – developer of www.bestendings.com, shares the impact it’s had on him, as we talk and talk about and through aspects of dying and death, medical interventions, personal decisions. Mike...

5 Steps to a Patient Centered Hospital

Which came first: hospitals or patients? Although filled to the brim with patients, hospitals were created to support doctors, not us patients. Historically, their organizational structure focused on doctors’ needs and doctors’ requirements. The concept of centering hospital care on patient needs and requirements is a relatively recent development. How can a hospital switch from being provider-centered to patient-centered? Shifting such a complicated and cumbersome behemoth a full 180 degrees is a huge undertaking. I believe it can be done. I’ve put much thought into this and feel my 5 steps are do-able and (relatively) easy to implement without interfering with the changes already in evidence organizationally and technologically. My 5 steps were born of an epiphany: Without us patients there would be no hospitals. Without us patients, there’d be no place for: practical teaching developing best practices; or solving health puzzles patients often present. Patients are hospitals’ raison d’être.  Here’s how you can make us feel more like the VIPs we are. 5  Steps to a Patient-Centered Hospital 1. Be Quiet. Quiet. Shhhh. We need a library environment. I don’t want to hear staff shrieking to one another down halls and across nursing stations. You have other options. You can get up and walk over to the person you are addressing or send a text (SMS, IM etc.), a Twitter message or an email. Silence the doors, drawers, cabinets, carts. No more slamming, ramming or bashing. We VIPs have sensitive ears and nerves. I know this quiet can be done. On hospital’s office floors for example, it’s dead quiet. 2. Paint. Hospital colours are depressing. We need something...