Hospice Talk

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From Deseret News, "How will I die: the high cost of death"

This article is part 5 of a 5 part series (there are links to the others on their page.) They are very interesting and worthwhile!

Here's the link:  www.deseretnews.com/article/765555271/How-will-I-die-The-high-cost-of-death.html

Suggested by Amy Madigan-Dube
From Hospice News Network, sent weekly to the Pine Tree Hospice office.

Dr. Craig Bowron, Minnesota hospital-based internist, wrote an article published in The Washington Post. Bowron begins his article about attitudes toward death with a discussion of an elderly person with multiple chronic conditions admitted through the ER. Of people in that condition, Bowron says, “The potential complications of any therapy are often large and the benefits small. It’s a medical checkmate; all moves end in abdication.”

If Bowron is lucky, he says, the family will realize that more care is futile. If he’s not, “The family may ask me to use my physician superpowers to push the patient’s tired body further down the road, with little thought as to whether the additional suffering to get there will be worth it. For many Americans, modern medical advances have made death seem more like an option than an obligation. We want our loved ones to live as long as possible, but our culture has come to view death as a medical failure rather than life’s natural conclusion.”

The unrealistic expectations arise in part from a misunderstanding of the increase in life span of the average American during the last century. While medical science has certainly made dramatic gains, other factors weigh heavier. Infant mortality in the U.S. in 1900 was 10%; by 2000, it was .69%. Improved public health measures such as better sanitation and nutrition, and improved maternal mortality count for more than “open heart surgery, MRIs or sophisticated medicines.” Bowron thinks that modern medicine “may be doing more to complicate the end of life than to prolong or improve it.”

Another major factor in “denial of death” has arisen because of the nation’s move from a rural to an urban lifestyle. Death was a fact of life in America a hundred years ago – today it is “a rarely witnessed, foreign event.” Bowron writes, “The farmers I take care of aren’t in any more of a hurry to die than my city-dwelling patients, but when death comes, they are familiar with it. They’ve seen it, smelled it, had it under their fingernails.”

The nation is more mobile and more affluent. Rather than three or four generations of a family living in one home, or near each other, the elderly are relegated to nursing homes and assisted living centers where no younger members of the family witness their struggles. Bowron says, “Sequestering our elderly keeps most of us from knowing what it’s like to grow old.”

Bowron says the distance is obvious when it’s time to make end-of-life decisions. He writes, “Suffering is like a fire: Those who sit closest feel the most heat; a picture of a fire gives off no warmth. That’s why it’s typically the son or daughter who has been physically closest to an elderly parent’s pain who is the most willing to let go.” An estranged family member may fly home to straighten everything out, but Bowron says, “She’ll have problems bringing her white horse as carry-on luggage. This person may think she is being driven by compassion, but a good deal of what got her on the plane was the guilt and regret of living far away and having not done any of the heavy lifting in caring for her parent.”

He writes that ,at some point, “Aggressive medical treatment can become sanctioned torture.” He cites a retired nurse as saying, “I am so glad I don’t have to hurt old people anymore.”

Bowron concludes, “When families talk about letting their loved ones die ‘naturally,’ they often mean ‘in their sleep’ — not from a treatable illness such as a stroke, cancer or an infection. Choosing to let a loved one pass away by not treating an illness feels too complicit; conversely, choosing treatment that will push a patient into further suffering somehow feels like taking care of him. While it’s easy to empathize with these family members’ wishes, what they don’t appreciate is that very few elderly patients are lucky enough to die in their sleep. Almost everyone dies of something.” (The Washington Post, 2/17, www.washingtonpost.com/opinions/our-unrealistic-views-of-death-through-a-doctors-eyes/2012/01/31/gIQAeaHpJR_story.html)

Suggested by Amy Madigan-Dube
Last Words, Last Connections

An article from The American Speech-Language-Hearing Association website about how augmentative communication can support children facing end of life

Link to the article
Suggested by Beth Ranagan, Pine Tree Hospice Board member
Months to Live

The New York Times has published several articles in its "Months to Live" series. The most recent two are "Hard Choice for a Comfortable Death: Sedation" and "Weighing Medical Costs of End-of-Life Care."  In addition to the articles, there are slideshows, photographs, and letters to the editor.  To see the entire series, go to www.nytimes.com and search for "Months to Live."

Link to the Article
Suggested by Amy Madigan-Dube
Make a Difference Movie

The Make A Difference Movie - The Teddy Stallard Story - by Mary Robinson Reynolds  The MasterMind.  I just watched this short movie and it certainly reinforces the work we are doing at Evergreen, the Pine Tree Hospice Center for Grieving Children and Their Families. Erin Callaway and I hold Bereavement Volunteer Facilitator Training sessions.  Please let either of us know if you are interested in learning more about the training or the Evergreen program. YOU can make a big difference in the life of a child.

Link to the Movie
Suggested by Cynthia Scott, Pine Tree Hospice Volunteer
Letting Go

Amy recommends an article in the "New Yorker" called "Letting Go: What Should Medicine Do When It Can't Save Your Life"  "Modern medicine is good at staving off death with aggressive interventions...and bad at knowing when to focus, instead, on improving the days that terminal patients have left."

Link to the Article
Suggested by Amy Madigan-Dube
The Hidden Costs of Caregiving

Caring for an older parent or an ill spouse can be a labor of love, but it can also take a toll on you emotionally, physically and financially. While many caregivers are not fully prepared for their new role, it is important to understand the impact that caregiving may have on your own pocketbook and retirement savings — and how to plan ahead so you can avoid bankrupting your financial future.

Link to the Article
Suggested by Amy Madigan-Dube