Farming the Dying, or Not

I got to talking to a new friend the other day and he shared how his father had lingered in a comatose and vegetative state for years. He had stiffened up and his body had begun to rot with widespread infection and skin breakdown. Is it PC to say that? No, it's not. But is it true? Yes, it is.

I've taken care of many patients who are in the condition of existing here for a heartbeat and a breath but who have had no meaningful movement or utterance in years. Is this not a cruel way to exist? The usual solution to setting on this path is to not make your wishes known ahead of time or to fall into the hands of people who really want to help. The pressure is placed on family to allow the placement of a feeding tube and possibly IV's. After all, you wouldn't want Dad to starve now would you?

There are various levels of consciousness and volition in the dying patient of course so one patient may just lay there and not be able to move and others may have dementia and move a lot and do things to hurt themselves inadvertently. There are many shades in between.

As death draws near the appetite diminishes and the desire for water is not keen. In someone who is well onto dying of an illness such as cancer the usual litany of "life saving measures" may be an unfair burden on the dying.

Performing CPR may splinter the bones in the chest. That sounds bad, huh?

Feeding tubes are often placed through man-made openings into the lower abdomen and are portals for infection, especially in someone who has little defense left. They feel alien and weird and it is not uncommon for patients who are confused or experiencing altered mentation to simply tug on them and dislodge them. Same with IV's and catheters. This can lead to further procedures and discomfort to put them back in place.

The consequence of the feeding tube is increased calorie intake but it usually ends up causing significant diarrhea and this puts the skin at risk of break down which then can lead to infection and sepsis. Also it puts the dying person at risk of aspiration if the head of the bed is less than 30-40 degrees. Once tube feeding solution gets in the lungs -and it can- everything falls apart. Chemical pneumonia in a compromised person is very hard to combat.

Those given IV's or parenteral/IV feedings (less common but possible) are exposed to fluid overload in the lungs as the body systems struggle to get rid of extra fluid. Fluid in the lungs makes it hard to breathe. The glucose solutions in parenteral feedings are so high that blood sugars are commonly checked around the clock in institutional or hospital settings. Prick, prick, prick.

It's hard to be a "good" dying patient and not pull out tubes and endure the sticks and the raw skin that develops from the various interventions. In some settings the next step may be using restraints to keep the person from pulling out the tubes or otherwise "messing things up." In the hospital I worked in I was a restraint trainer for a short time and then our hospital went to a policy of not restraining patients at all except in the absolutely most extreme cases.

It made for an interesting day walking into a room and seeing the patient with her catheter coiled up in her hand, or strangely, stuffed in the pillow case. It made for a heart-wrenching day when patients coughed up tube feeding solution.

Is this how the end of life should be? Is this what you want for yourself or your loved ones?

Death can be a kinder experience for many people. We have to have the conversations with our families and doctors and know what the options are. Hospice care can be delivered in a multitude of settings including the home, the hospital, freestanding outpatient facilities and freestanding hospice units.

Is a dignified, kinder death what we want to harvest at the end of our lives or do we want to be farmed out to care that is unlikely to cure and quite likely to cause pain and discomfort? Do the extra moments of "being here" deserve the sacrifice of dignity and self-determination?

What do you think?

Sherry

Addressing the Culture of the Spirit

The health of the spirit is often overlooked. I think it's important to understanding the person you are dealing with.

You can throw one pill after another to stave off or placate the manifestations of illness but a hands on empathetic approach to understanding the human being underneath it all can make all the difference.

Writing prescriptions or handing someone a pill is easy. Understanding why they are not healthy, why they are in pain or why they do things to hurt themselves is not.

Do you understand the culture of the human spirit? You may be well traveled geologically but have you ever explored the culture of the elderly, the dying, the grieving or the abused?

It requires a few things. One is exercising the art of shutting up and listening, while another is the art of setting aside time. Another is offering comfort. How long has it been since you shut up and listened without offering an interpretation of what someone is trying to say? When was the last time you simply sat with or spent time with a friend, family member or stranger? Do you give freely of your hugs? Do you find out where a person hungers and try to help him find sustenance?

Life can be fast-paced and hectic but people invite the madness into their lives. Do you chase the material stuff in life? Do you work lots of overtime to "get ahead"? Do you pay other people to care for your kids so you can chase those things?

Do you put off seeing your parents or your family? Have you lost touch with people you care about? Do you think neighbors should remain nameless behind the doors in your neighborhood? Do you find coworkers annoying and avoid most of them?

Does it make you mad to hear about old folks dying because they were cold, hungry or didn't have enough food? Does it make you angry that children are abused? Does it gripe your ass that crazy people pull out guns and shoot up neighborhoods, schools and other places?

Or, do you philosophize that people should "suck it up" and get over whatever issues they have? Do you say "it's not my problem." Or, think ........."WHY DIDN'T SOMEONE DO SOMETHING?"

Each of us can make a difference. It's time to start. You can be a hero by just being there, listening and offering the comfort of touch.

Ideas on Coping with Workplace Stress for Better Health

I think about ways that people can approach health and wellness and where we can fail or succeed. How many times have you run out and bought gym equipment or a membership or somehow made one more promise to yourself that you will "stick to" a plan to get healthier?

If you didn't raise your hand then I am surprised.

Do you beat yourself up for not exercising or for "not having enough time?"

Where do you spend most of your day when you don't factor in sleep? Most would probably say "work." We spend a lot of time chasing a dollar to make ends meet or to have more stuff. There are innovators in the workplace who have made work more tolerable, occasionally entertaining....... hell a few places even make work more fun. Unfortunately, there are many punitive workplaces.

Dread going to work? Do you ever get the feeling like you would like to scream or run away or just plain quit? How do you manage your stress level at work? I think that addressing the roots of an ongoing stressful situation would keep people from simmering over at work, on the subway or the bus, reduce road rage and keep spouses and children a little safer at the end of the day.

Not everyone takes their unresolved stress out on others. Many turn their feelings and thoughts inward and some become depressed. I would posit that there are little changes employers and their minions could make to ease up stress in the work place.

Right now there is a somewhat punitive approach to healthy lifestyle in the work place. If you smoke you pay more. If you have pre-existing health conditions they may be excluded from your plan. If you aren't willing to eat through your lunch at your desk your co-worker may be seen as harder working and more apt to get a promotion. And if all the sitting makes you fat.......

If you don't "perform" - even though you feel you are always running as fast as you can - the threat of job loss or no raise or demotion may hang over your head. Is the boss always screaming? Do you have a toxic co-worker or two? Are you increasingly depressed or hostile?

How many drinks do you toss down after work before you feel better? How many potato chips do you eat? How many cigarettes do you smoke? How many hours do you feed avoidant behavior such as shopping, gambling or gaming? How many times do you project your anger or distress on your family because you don't have a way to get out those stressed out feelings from work?

I would like to see employers open up to the idea that stress reduction, and a friendly, respectful, and supportive environment, is highly beneficial to the health of the employee and the company's bottom line. It really doesn't have to cost a lot.

1. Don't tolerate bullies in the work place. Toxic employees and bosses need to go if they berate, belittle or otherwise foster or create a hostile environment. I learned a long time ago that no one is indispensable.

2. Set aside a small room or large closet and put in a little carpet or leave mats and chairs in the room along with a CD player and some soothing music or nature sound CDs. Stressed out employees can take a break in this room if need be. Meditation or music CDs can be available. A dimmer switch is perfect for getting the lighting just right.

3. Set aside a space for a fun room or a fun space outdoors. Invest in simple art supplies, coloring books, cartoons on CD for the indoor space and simple sports equipment for the outdoor space. Set up Guitar Hero in the fun space.

4. Teach interpersonal communication techniques and expect respect in the work place. Have a plan for conflict resolution before things escalate.

There are costs associated with stress including the taking of excessive sick/mental health days, poor day to day performance and consequences of poor health habits not to mention injuries in the work place.

I know many adults who enjoy coloring books, cross words and sketch pads. I've seen them use jump ropes and hula hoops too.

We live in a cover your ass kinda world, in the US anyways. Lighten up!! Taking care of stress is just as important as eating, drinking exercising and breathing. Since people spend so much time at work why not incorporate tools for a more positive way to cope with stress? People you work with are like the family you didn't choose, lol.

I can already hear some folks yelling "grow up!" thinking this is kid stuff. But people who remember how to be joyful and playing like a kid, how to be childlike (not childish) and be flexible and friendly are the most likely to thrive despite workplace pitfalls.

Besides, it's really tough to hate a coworker while she's playing with a hula hoop.

Sherry