Archive for Death

Death is (Not) the Enemy

Hospice always fails you. With few exceptions, our patients . . . die.

Death is a defeat, often perceived as a human failure.

Death is to be battled, and everyone schemes to beat it.

Death is a problem to be solved. On the moon-bound and suddenly crippled Apollo 13, Commander James Lovell famously said, “Houston, we’ve had a problem.” The prospect of death, between earth and the moon, between our first wail as a newborn and before whatever last breath is taken, should be confronted and conquered.

Avoid death!

Anyone working in hospice has joined the grim reaper gang. We mingle with the life insurance sellers and funeral directors, the coroners and the grave diggers. We are purveyors and surveyors of the forbidden topic. While the rest of society runs from the dying, we stay.

A hospice nurse, training similar to her counterparts in the hospital corridors and emergency rooms, begins the day with a list of patients to visit. While her colleagues are calming a mother about to give birth or prepping for surgery, and will give their all to bring and extend life, the hospice RN has other thoughts . . .

  • Will my patient die today?
  • How can I help her or him die peacefully?
  • How can I honestly answer the family’s request to know when death will come?

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A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”

With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.

Was the chaplain, a person and a professional I respect, correct?

What is quantified? It’s a word describing precision, numbers, and comparisons.

A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.

The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.

  • Is the patient losing weight?
  • Does he require stronger doses of pain medication?
  • Is she eating less, or only liquids, compared to last week or month?

Yes, nurses quantify, with specifics, to discern a patient’s changes. Read More →

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Please, Don’t Say Hospice or Mention Death

How do you share openly about dying with those that don’t want to speak or hear the word, “Death?”

How can a hospice staff—whether home health aids, chaplains, or nurses—explain who they are and what they are doing when a patient’s family instructs them not to mention the word, “Hospice?”

In our patient care meetings, especially with newly admitted hospice patients, a month doesn’t go by without mentioning one or both of these questions.

Since hospice involves caring for the dying and supporting the bereaved after death, sometimes the staff can’t talk about their real work with the people they serve.

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What word do you use for death?

  • Is a person lost?
  • Have they transitioned?
  • Are they gone?
  • Did they pass?
  • Is your loved one in a better place, standing at heaven’s gate, meeting Saint Peter, or with the angels?

Since the beginnings of my ministry, I have used dying, death, and died. I suspect, over the years, in person and on the phone, I have upset people with those unadorned words. Read More →

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