Final Conversations
May 2, 2013 | 
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The German poet Rainer Maria Rilke said, “A person isn’t who they are during the last conversation you had with them – they’re who they’ve been throughout your whole relationship.” Is this true even when the “last conversation” is the very last conversation prior to death? I have always been a believer in the power and possibility of an individual’s transformation as death approaches. I’ve seen amazing final conversations that involve forgiveness and healing that could not have happened apart from the context of imminent death. And so, when contemplating this quote and whether or not it applies in the face of a literal final conversation, my first inclination is to say no, the very last conversation can be even more powerful than who this person was during the whole relationship. Read the rest of this entry »
The Name Debate: “Palliative” vs. “Supportive” Care
On this issue I’d long been a believer in “palliative”. After all, most Americans don’t know what palliative care is http://bit.ly/jIChMM and so it seemed an opportunity to build awareness behind the concept. (This is the ideal marketing situation where you get to define what your product or service stands for.) Read the rest of this entry »
Reflections During Holy Week
Almost every year I tell myself that this will be the year that I create a series of visual images in response to the Stations of the Cross. Sometimes I am lucky enough to make a drawing. This year, I thought that I could write an essay for this column. Read the rest of this entry »
Death and Dying in Nigeria–A Social Commentary
The Bible says "there is a time to be born and a time to die". This saying reminds everyone of our mortality and the debt. A discourse about dying and death in most human society including Nigeria is a taboo. Read the rest of this entry »
Spotlight on Veterans
In the hospice community and within the Department of Veterans Affairs, it has become known that approximately one-fourth of all Americans who are dying are veterans. Read the rest of this entry »
Give me liberty or give me death (via aggressive medical care)
An NPR story last week described Americans as more willing to support policies if they’re framed in the language of individual liberty instead of benefiting the common good. This was discussed in the context of gun control. But it has ramifications for end-of-life policies as well. Read the rest of this entry »
Sticking Together
"Are you coming in?" the nurse asked.
"As soon as you finish," I replied.
She said the patient had just been extibated (breathing tube removed), and was already turning blue. The respiratory therapist was just finishing up, and I gowned, gloved, and masked to go in to see the isolated patient. Read the rest of this entry »
Online Memorials
There is little question that the internet has changed our lives in North America and many other places in the world. I can hardly remember how I used to get accomplished some of the tasks that I do online before the days of the internet.
The internet has also influenced palliative care. People diagnosed with illnesses and their families seek out information and can obtain it in ways that were not always so readily available to everyone. The accuracy of the information is always a concern to care providers but the availability of reliable sources has increased along with the general understanding of how to assess that reliability. Read the rest of this entry »
Trending Now: #TBCP
If palliative care was a business one could say it is in the midst of a brand crisis. (See my earlier post- The Conversation Stopper). Luckily the brand is both evolving and expanding as healthcare reform germinates in the US. Also recently the #HPM and healthcare literature in general appears increasingly peppered (in no small thanks to Dr. Ira Byock) with aspirations to ‘the best care possible’. I worry that this sound bite will rapidly become a cliché and lose its oomph. I hope it won’t. Read the rest of this entry »
“If You’re In, then I’m Out”
"If you're in, then I'm out."
I see this routinely in the charts of patients referred to our outpatient palliative care program:
“Will defer further outreach and follow-up as patient has been referred to palliative care.”
“Patient to be followed by home palliative care, so no further follow-up needed.”
“Patient interested in hospice care, but will defer discussion to palliative care.”
A few days ago, a primary care RN told me, “if you’re in, then I’m out.” Read the rest of this entry »
Posted in nursing, Opinions, Palliative Clinic, Patient Centered Care, Uncategorized | 
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February is Women’s Heart Health Month
The majority of Caregivers are women, caring for their children, their parents, their partners, and their spouses. Because it’s not uncommon for Caregivers to put their own health needs aside to focus on the needs of their loved ones, VA wants to make sure our Caregivers know about heart health.
Did you know that heart disease is the #1 cause of death in women? The good news is, there are several things you can do to help reduce your risk of heart disease. February is Women’s Heart Health Month and the VA is here to make sure the “beat goes on” for women Caregivers and Veterans. Read the rest of this entry »
Trail of Tears
When I encountered the word journey in hospice, I thought of a spiritual journey. As I discuss dying with patients and families, I realize that they are referring to the physical process of dying. Discussions include questions and comments like the following:
“Is she dying?”
“They told us that he was dying. We travelled home. He didn’t die.”
Families reference hospice brochures regarding physiologic changes that occur. Often, there were not discussions of the changes associated with medical interventions. Read the rest of this entry »
Death and Dying in the Magic Kingdom
I just came back from teaching a palliative nursing course at the Disneyland Hotel in California. That might seem an odd juxtaposition but, from a self-care standpoint, it was great.
First, the hotel is consistently, and occasionally relentlessly, cheerful with perky “cast members” greeting you brightly at all hours of the day. Guests walk around wearing Mickey Mouse ears, princess dresses and tiaras, and other aspects of various Disney characters. The weather was gloriously sunny, and warm.
The course was the End-of-Life-Nursing- Education Consortium’s (ELNEC) Summit. This is the concurrent offering of its Core, Critical Care, and Pediatric Train-the-Trainer curricula. Read the rest of this entry »
Posted in Caregiver, Coping, Education, nursing, Self care, Uncategorized | 
Tags: ELNEC, nursing, palliative care, Self-care | Comments Closed
Smiling Because It Happened
At the close of a difficult 2012, a good friend of mine sent out holiday greeting cards with the following quote from Dr. Seuss in his message: “Don’t cry because it’s over. Smile because it happened.” In our end-of-life work, which is so much about supporting family members of patients as they grieve, and supporting our fellow staff members as they work through their own losses or react to the death of a patient, this bittersweet quote has special significance.
What strikes me about it first is its emphasis that something is finished. A death has occurred, but also a relationship has ended. Many years after a death, there may still be crying because, indeed, a relationship is over and the deceased person is desperately missed. In his second sentence, Dr. Seuss gives us a message of hope…that we can, someday, get to a place of happiness and joy about what we once had but is no more.
But, there is a chasm between this quote’s two sentences. Thankfully, our human nature is to build a bridge over that chasm, because we need to cry over our losses…and we deserve to feel happiness about what used to be. As we all know, we often feel both sides of the bridge simultaneously, or we are rushing back and forth across the bridge in feeling happy and then sad again about the death or loss. We can hope that eventually, after much bridge crisscrossing, we will spend more time on the side of the bridge where we are smiling because it happened.
What Such Acceptance Looks Like
“Tell me,” I ask, “what’s most on your mind this morning?"
“Dying,” he says, softly, “dying before I’m ready.” Read the rest of this entry »
Posted in Cancer, Coping, Dying, Humanistic medicine, Humanities, Life's like that!, Reflective practice | Comments Closed
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