CARING WITHOUT CURING- IT

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CARING WITHOUT CURING- ITS OK TO DIE Part
TwoPsychologyofDeath and Dying

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Ways to Die

• Sudden death, unexpected cause
• Steady decline, short terminal phase(cancer,
  advanced life-threatening disease)
• Slow decline, periodic crises, sudden death
  (organ-failure, frailty)

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End of lifein America today

• Modern health care
• only a few cures
• live much longer with chronic illness
• dying process also prolonged

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2 roads to death
THE DIFFICULT ROAD
Confused
Tremulous
Restless
Hallucinations
Normal
Mumbling Delirium
Sleepy
Myoclonic Jerks
Lethargic
Seizures
Obtunded
THE USUAL ROAD
Semicomatose
Comatose
Dead
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Changing Gears

• Teach family the what to look for
• Rattling, noisy breathing
• Cold extremities
• Skin mottling
• Patient unrousable
• Irregular breathing agonal breathing
• Notify family members early of decline

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Explanation

• Reduces fear reduces pain suffering
• Improves compliance with treatment
• Uncertainly is intolerable
• Diagnosis is the beginning of treatment

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Death Anxiety

• Death is a primordial source of anxiety- we all
  have it deep within us.
• Most of us convert it to something less
  threatening by denial, or transference
• One person may choose to believe in his/her
  specialness and inviolability another may
  believe in an ultimate rescuer.
• We all prefer not to think about death- for us,
  for our families, and for our patients

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Confronting the Reality of Death

• Kubler- Ross denial, anger, bargaining,
  depression, finally acceptance
• Loss of control function, decisions, dignity
• What have I made of my life?
• How do I want to be remembered?
• Healing relationships with family and friends
  (before its too late)

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Distancing Tactics

• Premature reassurance
• False ressurance
• Normalising
• Selective attention
• Jollying along
• Passing the buck
• Turning a deaf ear
• Concentrating on a physical task
• Inappropriately introducing humour
• Disappearing from a stressful situation

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GOOD FINISH

• You are important to me.
• Forgive Me
• I forgive you
• Goodbye

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Guilt and Blame

• Doctors Did I do enough? Did I do something
  wrong?
• Families Mama will die because we withheld (or
  withdrew) treatment
• Nurses Im afraid Ill be blamed if this person
  dies
• Patient I neglected my health and now its too
  late

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• BLESS
• OR
• CURSE

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Grief and Bereavement

• To deal with loss of any kind, one must
• A) Accept the reality of loss
• B) Experience the pain caused by the loss
• C) Adjust to the new environment after the loss
• D) Rebuild a new life

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GRIEF WORK

• Find the words
• Say the words
• Know the words have been heard

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GOOD THERAPIST

• Accurate Empathy
• Non-Possessive Warmth
• Genuine
• Seen as Competent
• Yalom-Group Therapy3rd Ed

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• LISTEN
• REPEAT
• USE A FEELING WORD

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Summary

• It takes time and experience to become
  comfortable dealing with death and dying.
• The more involved you are in the process, the
  easier it becomes.
• You become a humanist as well as a scientist, a
  friend and a comforter- what a physician should
  be for the dying patient.

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