Grieving … an Important Process

                  Last week there was an article in the New Yorker about a lady who experienced a live birth in Mongolia after being pregnant for only nineteen weeks.  The baby did not live.  Later she was given a clinical reason called a “placental abruption” for the early delivery and was assured she did nothing to cause this early delivery. 

                The young woman describes her response as being “so sad she could barely breathe” and her marriage failed within a few weeks.  She still feels what she describes as a very “dark hurt” and at certain times she suddenly starts crying; although most of the time she seems “sort of okay.”  I wondered how a mother or father could ever overcome such an intense, sad feeling. 

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                According to Dr. Kenneth Doka, there are different styles of grieving.  Intuitive style is for the most part more responsive, open and emotional.  The instrumental style person will articulate their feelings in a more masculine style as they cognitively and physically work through the grief.  However, neither style is gender specific.  Men or women can grieve either way depending on the individual.

                Many years ago, my friend miscarried only two months or so into her pregnancy.  The doctor assured her that she was no longer pregnant, but he did little in welcoming her feelings during this initial phase of grief.  The problem was she felt as though she lost a baby and it was not simply a faulty “pregnancy.”  Times have changed and now, especially when the fetus is older at the time of loss, the parents get to see and even name the baby.   A funeral helps parents and family acknowledge that a life was lost.  However, in this case, my friend never had this closure.  Yet, both women have the same symbolic hopes for the child and both women feel the intense hurt in the loss. 

                Another factor in the process is feeling guilty.  My friend blamed herself -because she was cleaning with strong chemicals the week before she miscarried.  The woman in the story was assured that she was not at fault for the loss but my friend was not.  This is a heavy burden to carry especially if there is no proof she was at fault.  Sometimes these things are an act of nature.

                Grieving is important for everyone involved -both parents and the family.  There are different styles of grieving, however, mourning the loss may be necessary to overcome the deep sadness.  Carrying unwarranted guilt can extend the grieving process.  Time is probably the best asset for healthy grieving.  Even over time, some may never get over the loss and marriages sometime part over such things.

Sad saying 

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Taking Responsibilty

It is the American way to defend “freedom” for anything and freedom to choose whether or not to do advanced directives is no different.  This is demonstrated by the fact that two thirds of all people do not have a “living will” (see statistics in America as stated in the Jacoby’s article called [Taking Responsibility for Death ]).  Patients are reluctant to make these major decisions for many reasons including political, religious, not understanding medical procedures. Sometimes, the patient simply does not want to face their own mortality.  Americans should take responsibility to make their end of life wishes known.  Advanced directives should be seriously considered much before The Patient Self-Determination Act is enforced upon entering a hospital.  In many cases, a patient’s indecision can result in financial or emotional disasters for loved ones left behind.  If advanced directives are made while the person is alert, alive, and coherent, then loved ones will be eased from some burden.

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A family member may accept being a health care proxy.  If a person agrees to this, that person should do exactly what the incapacitated person would have wanted as though she was capable of making the decision himself/herself.  It is important the proxy clearly understands the dying person’s wishes to the best of his/her ability.  If the dying person never appointed a proxy, the surrogate must act according to his/her best knowledge of what the other person wanted –even when it was never explicitly stated.  This includes acting within the legal means of the law.

In many cases, a patient will never be as familiar with medicine as their doctor considering how extensively the physician has been trained and educated.  There are some traditional areas that advanced directives concentrate on, though, which may guide people through the decision process.

  • The possible positive and negative outcomes of procedures including cardiopulmonary resuscitation, feeding tubes, ventilators, and dialysis
  • Questions about pain and comfort
  • The organ donation procedure
  • The use of antibiotics which may prevent death by natural causes
  •  Do not resuscitate and the possibility of possible negative outcomes such as persistent vegetative state, locked in etc

The patient should also feel confident that his/her wishes will be upheld in the event of sudden catastrophe such as an accident.  At the end of this discussion, the person should have confidence the doctors will be forthright and honest about futility analysis.

The patient and family should clearly understand any decision that may affect their own body.  They should indeed question anything they do not understand – at any time.  This may include why a medicine is being given; what are the side effects; is medicine necessary; is it recommended; will it prolong death;   People must communicate openly with the doctor or else we limit our options and may not be comfortable with our decisions.

Letting Go Near The End

                The medical field should offer the dying person a “good” death.  Since people are individually unique, this “good” death is relative.  The patient centered approach is best.  This approach considers the patient’s interests when making healthcare decisions.  It is contrary to the physician centered approach where decisions are made without patient contribution.  The dying person should have the option of changing their mind about anything, at any time.  For some, it may mean dying in the comfort of your home surrounded by family but for others dying in a hospital with twenty four hour care -hence the term “dying with dignity”.   No matter where the death takes place, an interdisciplinary approach is necessary to understand and satisfy the dying person’s unique needs.

            The medical field should encourage the person to have advanced directives.  Any questions should be answered by medical professionals.  Decisions cannot be made without specific, honest and professional advice.  In the reading, we learned it is probably less painful to be hungry than to have a protruded abdomen.  So, depending on the circumstances, we may decide to forgo food.

                The doctor (unlike Monopoli’s) should make known to the dying person their disease state.  This honesty will allow time to be budgeted for the social and emotional closure the person needs.   These needs vary.  Some people will want formal goodbyes and some will be happy knowing that they are remembered. 

A small party can be assembled to tell the person how much they are loved and will be remembered.  The medical community must yield private time to allow these social and psychological finalities.

            Another area the medical community needs to address is keeping the dying physically comfortable.  Foremost, the doctor should alleviate any suffering by prescribing medication.  An aide may offer comfort by turning a fan on or ensuring there are no bed sores forming.  A volunteer can lightly massage aching hands or feet.  A counselor can help the dying who become depressed or anxious over family strive arising from the death.   The medical field must become part of a team.

            To conclude, a “good” death is characterized by an interdisciplinary approach in which the dying person is allowed to make decisions about their own end of life choices.  The medical personnel should make the person aware of their end of life choices and the progression of the illness so that the person can make wise decisions.  The doctor should always give honest opinions and help alleviate pain.  The person should be allowed to have quality time with their lifelong connections and say their goodbyes.

The team should be able to connect the person to community professionals for spiritual closure, for mental health services, and for taking care of any unfinished business.  And, last, it is my opinion that life should not be prolonged beyond futility.  Still, in the context of this reading, the decision should always be that of the dying whose wishes are most important. 

Death Portrayal in “The Bucket List”

                Humans seem to be the only creatures that have a concept of time in motion.  We are always advancing toward death and we know that death must come.  So why are we afraid to think about our own death?  It seems death is a normal, inescapable experience for the living, but many humans fear it, and many cultures avoid discussing it.

                One reason for this denial and fear might be because death no longer occurs surrounded by family.  Instead, hospitals have taken the family’s place and no longer have to face death “in the eye”.  One movie, The Bucket List is a comedic attempt at the very notion of death denial.  In The Bucket List, we see that chronic illnesses can afford a sick person, their family, and friends time to reflect on life and death.

                The title of the movie is a reflection of America’s death denying attitude.  The title is simply an extension of the euphemism “kicking the bucket” and is meant to lighten the viewer’s preconceptions about death in the movie.  The title focuses attention away from the death and on to the last stage of life.  Consider if the title of it was “Death Beckons”.  Would audiences still want to see the movie? 

                Many lines in the movie are thought provoking but one in particular stands out.  Carter is asked what he is doing in the hospital bed and he replies, “fighting’ for my life.”  His words indicate that he wants to live and demonstrates death denial because he sees his life being taken from him.  Although, he is actively dying, he did not outright say this because lying in the hospital bed disguises death and gives the dying person hope. 

                The movie displays some diverse aspects concerning death including spirituality.  Cole has unique unresolved spiritual issues and he states he cannot grasp the concept of faith.  Cole reacts to Carter’s faith stating, “Halleluiah, pass the mustard!”  Perhaps Cole fears the unknown afterlife.   The conversation brings to light that accepting faith is an individual experience with diverse outcomes.

                Both men deal with psychosocial matters before their deaths, but Cole has painful emotional issues to resolve.  Cole, looking ill, looks in the mirror and states that somewhere somebody is having a heart attack.  Until now, his life had been career climbing with him in control, and he would rather have evaded this confrontation by dying suddenly (like heart attack).  Cancer forces him to confront the unresolved emotional things.  Cole needs to mend his relationship with his estranged daughter and does so by kissing a beautiful girl (his granddaughter)—one of the last items on his list ( see http://www.youtube.com/watch?v=iioBwO6vnEs )

                Overall, the movie portrays the realistic yet diverse aspects of death: fear of facing the unknown, solitude, and denying life ends too soon.  In my opinion, a bucket list should embody not just one’s last days, but everyone should do their own “bucket list” long before facing death.