Saturday, October 24, 2009

Palliative (work stories)

Most of us would generally like to not think about when or how we might die. This includes me. But some days I am forced to think about it, because I see people in my line of work who are either close to death, or have already died. I have a few things to say about this. First of all, when I think about dying, I would really rather NOT do it in a hospital. I'd rather die in my sleep, after a peaceful, pain free evening of watching ocean waves or birds in the trees, or a beautiful sunset or something, in my easy chair or my own bed. But I've seen quite a few situations where people want to die at home but it becomes too difficult to get adequate pain control or to stay hydrated, and then they are tortured by the time someone calls an ambulance. It's hard to say what is better; try to stay at home until you can't handle it in hopes you can die at home, or plan to go to the hospital near the end? Home care can help, but if it isn't working for whatever reason, what is the plan B? I just hate to see dying people in pain. Like, writhing around and yelling pain. Some pain is sometimes inevitable, and something we have to come to terms with. But uncontrolled pain that can be helped by drugs or hydration, simple things we have to offer people to help ease the transition, is heartwrenching.
Sometimes I want to sign a DNR order now, while I'm in my early thirties and healthy, so I can avoid the indignities of a drawn out thing and the ICU and heroic efforts that simply prolong suffering or render someone's final days, months, or even years to a semi bionic existence hooked up to machines. But then sometimes I think I'd rather have all heroic measures taken, for the chance at more hours of life, more time with my family, and more opportunities to learn to embrace life fully. I have been to deaths where the person had signed a DNR order, but the particular circumstances surrounding their death made it such that full resuscitation was likely and a few more good years possible, but the DNR renders this all to speculation because we are not allowed to resuscitate. I have also been to deaths that are inevitable, long, drawn out processes and they DON'T have a DNR order and we are forced to perform CPR on someone who is very ready to die. I've also been to deaths where CPR is hopeless, and the person's situation is incompatable with life, but CPR is done anyways, for the sake of the people watching, so we can say we did everything we could. This happens more frequently with sudden or traumatic deaths. Like car accidents and stuff. There is a crowd of fifty people standing around watching and guts all over the road and car parts and engine oil; what do you do, just stand there? There is expectation thick in the air that you will do something. So we do CPR. And then we call it. And then we cover them up with a blanket.
All CPR is futile, because no one ever gets out alive. We are always simply posponing the inevitable. Of course, it's not entirely futile, because we would all appreciate a few more years on earth, given the choice.

I have to tell you, this would be my ideal way to die: after a meal of cesar salad and steamed crab, a long cuddle with my kids, and some quality time with my hubby, I'd like to die so instantly I have no idea it's coming. One second, happy and cozy, the next second gone. Preferably somewhere where my family doesn't have to clean me up, if it were messy, which it often is if death is that sudden.

Just so the universe is aware of my order, I'm going to put that out there. Request made. We shall see how it pans out.

Last week here in Chilliwack someone tried to order up their own death; they put a gun in their mouth, pulled the trigger, and the Universe said NO. Now he has a scratch on his nose, a hole in his mouth, and another hole in the top of his head. He's fine. Some sheepish, but otherwise fine. At least he didn't blow his face off and survive, which I've also heard of. If your gonna survive, it's better to have a face.


Sylvia H. said...

Dear Mel,

I love your writing and sharing on this issue. Just wanted to let you know that I am so passionate about end-of-life care (it's a calling from God)and I will devote the rest of my life in this area. Now I am in Alabama. I really enjoy the life here. Love & miss you, Your blogger fan...Sylvia

Roboseyo said...

well I for one, hope it's a long cuddle with your adorable great-grandkids, not your kids, that you get, before you go painlessly... or that your kids are still up for cuddling in their seventies.

Louise and Gary Chapman said...

Mel, my mom had palliative care at home until the very end. My dad and sisters (nurses) were able to admininster drugs to keep her as painfree as possible. Home care nurses visited and helped. I'd say the last week was the hardest, where she was lying in a borrowed hospital bed in their home, but she was the most comfortable she could possibly be, given the situation. She absolutely refused to be hospitalized and her wish was granted.
I don't know what the best way to go would be. I think I would like to make sure that I could leave a video message or letter for my kids and Gary before it happened. My mom left us with a letter and whenever I feel strong enough, I read it. So meaningful.