Month: November 2017

Dying is a very physical thing

~ endoflifematters ~ Leave a comment

Many patients tell me that they are “ready to go” and then struggle when they realize that making that momentous decision is not the deal-breaker for dying. Don’t get me wrong, it is important, but they often have not taken into consideration the importance of the mind-body connection in the act of dying.

This is particularly true for the most spiritual patients whom have spent a life developing their spirituality within their religion or those who have spent their life working with their high-functioning mind in fields such as science or mathematics. Our minds are amazing tools we use each and every day,  but sometimes at the end of a life, it is very difficult to turn that tool off and let it go. Particularly when we believe it has maintained order in a chaotic world and for many, the end of life is the most chaotic time they can imagine and so they clutch to their mind at that time. Using it to take control of their weakening body.

Now you would think that people that were very athletic in life would fare well in this physical feat of dying, but alas, they too have used their mind to help get the most out of their body, often pushing it to the limits. They too struggle in their final days as the very thing that gave them vitality in life keeps them going on, defying every physical challenge that comes along. Family will often state proudly, “…oh they are such a fighter!”, not realizing how fighting death is a negative.

The Buddhists have wisely understood the mind’s powerful lock on our ability to let go and created one of the most effective practices in preparation for the time of death; that being meditation.  Meditation is a life-long discipline we practice over and over again, with our own death very much as motivation.  The Tibetan Book of the Dead  is all about this very idea but it is not an easy text for a westerner to understand and in the Buddhist tradition it is thought to take a lifetime of practice to master its instructions.

Prayer is certainly a form of mediation for many but not always the dependable discipline that meditation seems to be. Regardless of of your religious or philosophical practice, the underlying fact for us is that when we die, we must be at peace with our body and switch off our mind.

Acknowledging that our body is going to die is something we must all do at some point. Often our body can no longer go on due to a disease process and despite our best efforts to halt the disease, the body will die. That means the mind too.  Yet the mind, with fear fueling it along, can keep a body going much longer than it need do and it can seem like unnecessary suffering as the dying person hangs on and on and on. The family becomes fatigued and overwhelmed by the question of “…why hasn’t our loved one died when they said they were so ready?”

I have always felt that death is the reverse of being born and equally demands the physical exertions of labor with its different stages, transitions, peaks and troughs. The hospice RN is the mid-wife, guiding the dying person to their final breath. I often try to check in with my patient to find out how their mind-body connection is. If they are struggling, I will speak gently with the dying patient of giving thanks to their body for all it has done in this lifetime and to take this time to say goodbye to it with peace. Sometimes just talking of what is likely to happen as the person is dying can help give them a guide for what is to come and allow them to get rid of their fear of the unknown. Finding out what form their fear is can help guide what is needed.

Often we use medications to help the person with the pains of their labor. Pain can be caused by many physical forms due to disease process and shortness of breath as respiratory and circulation function slows down. Other forms of pain can be due to the mind-interference of fear generated by hallucinations and other mental disturbances caused by chemical imbalances as the body attempts to  shut down. Dying is a very physical act and everyone will do it in their own unique way, just as every birth is unique.

How is your mind-body connection? How will you prepare your mind to let go when the time comes?

Of course the other aspects of dying such as spiritual, emotional  and mystical (none of us knows what is happening) will always be with a person as they die but first and foremost, death is physical and it is a good start as we prepare for our final days.

Jan R

 

 

End of Life Matters (it really does)

~ endoflifematters ~ Leave a comment

This blog is going to be all about End of Life (EOL) care, and matters pertaining to the end-of-life, hence the name!

I am an Australian who is a hospice RN and I work in a skilled nursing hospice in Minnesota. I have been in hospice for the past five years and feel strongly about advocating for my patients as they move toward their end of life.

I went into nursing solely to be a hospice RN later in life. Let me tell you a little of my story that led me to being so passionate about hospice and end of life care.

My parents died when I was young. My father died from colon cancer when I was 11 years old (1975), and my mother died from cardiac disease when I was 22 years old (1986). My older brother (15 yrs older) died, six months after my mother died, from a pain medication overdose (self inflicted). In 1986 after having experienced two significant deaths in one year and being 22 years old, I was raw with grief.  I was open and needing to process more deeply the extensive grief I felt from those deaths. Two deaths in one year would be enough to say I  would be prone to complicated grief, but with the previous death of my father 11 years earlier, I was most certainly faced with a complicated grief. Luckily for me, I had a dear mentor who pointed me toward the writings of Elizabeth Kubler Ross.

So began my life-long quest to find out as much as possible about death and dying in our culture and other cultures.

In 1975, and being 11 years old, I was not allowed to grieve the loss of my father in any healthy way. At that time in Australia, death was most certainly rushed away from the eyes of children. The predominate thinking was to shield children from the “nastiness” of death. I was not with my father when he died in the hospital. I was not taken to see him when we found out he had died.  In fact my mother didn’t even go to see him. The thought of him dying alone in a hospital bed haunts me.  I fought to be allowed to go to my father’s funeral and had a down-right temper tantrum to be included in the procession to the crematorium. My instincts thankfully knowing I needed that much.

Throughout my teenage years, my grief was suppressed and never allowed to be processed. I was never allowed to speak about my feelings about my beloved father’s death, let alone express them. So, when my mother died in 1986, it was not surprising that my grief was compounded by the realization that I no longer had any living parents. All that unprocessed grief from my father’s death was released with my mother’s death. Six months later my brother’s untimely death compounded my very complicated grief.

As a young 22 yr old, I struggled with the overwhelming grief I felt without any real assistance from counseling or other support. My friends were all busy being in their twenties and so their understanding of what was hitting me was limited.  My mentor gently guided me with reading material and  timely conversations that left me thinking. Eventually, I left for Europe perhaps to escape the overwhelming hole I felt in my life. I traveled with a dear friend and together we had many adventures traveling and working in England. We both met our husbands and our lives took off in new directions.

My husband was from Minnesota (I knew nothing about the place) and he and I connected because his beloved grandfather had also died in the previous year. He was working in England at the time and our romance was grand. We were married in England 2 years later.

Our first child, born in San Francisco, was a complete joy for us but when he was just 2 yrs old he was diagnosed with Acute Lymphoblastic Leukemia. He was with us for only a short time and died at the age of  5 yrs. It is at that time that my grief fell off the edge but this time, we had amazing support from our community and I had my husband who shared our extreme grief. Our second son (2 yrs old at the time of death), kept us going and then two years after our first son’s death, we had a daughter. We went on and my true education of hospice began.

It is true that our life experiences are our greatest teachers. I hope you find my reflections on end-of-life matters helpful and thank you for reading.

Jan