Tuesday, January 28, 2014

A different approach to the end of life - a guest blog from Molly Yarger

    This blog is a guest post from my daughter Molly.  Shortly, she'll finish her last few courses, a clinical and then her licensing exam, but if this blog is any indication, I'd say that she's ready now.       

As I sat and listened to a long-time hospice nurse speak to my senior nursing class, I was moved. My eyes welled up with tears, though my calculated stoicism allowed none to fall, as she described her experience with hospice patients. I had been removed from the geriatric population, it seemed, just 
long enough to begin to lose some of my passion for nursing. By the end of the address, however, I began to feel that old familiar inspiration that initially drove me toward nursing as both a career path, and a lifestyle. My passion was renewed just when I needed it (perhaps by chance? divine intervention? I’ll let you be the judge).

Modern medicine can accomplish some amazing feats. The treatment and eradication of illnesses continues to improve day by day. That being said, modern medicine is also mainly concerned with “treating.” A terminal diagnosis ends the possibility of eradication. When a terminal diagnosis occurs, therefore, it as treated as a perpetual end point for modern medicine. Many patients feel a sense of powerlessness.

Simultaneously, this is the beginning of end-of-life (and hospice) care. We cannot change the terminal nature of the diagnosis. We are nurses whose patients are headed toward imminent death. These patients feel as though their power has been stripped.

The inability to “cure” our patients, however, does NOT mean the inability to restore this power. We treat our patients holistically. That is, we care for our patients’ bodies, minds, and souls. Rather than falling into the trap of perceived powerlessness due solely to terminality, we take an active role in empowering our patients. They cannot, unfortunately, “conquer” death. This can be difficult for 
patients to accept. We do everything in our power to ease them through this difficult process. Once acceptance has occurred, we are able to move forward and place the focus on that which the patient may control. We assist them in reframing their thinking to help them understand that they DO have power to make decisions specific to their individual preferences. The patient DOES have the power to choose whether they’d like to pass on at home or in a hospital setting. They have the power to choose how sedated or non-sedated, they’d like to be. They have the power to choose which activities they participate in “just one last time” (or even for the first time) before they go. They have the power to choose to see those they want to see. Often patients will hold on just long enough to hear someone’s voice one last time. Sometimes they’re waiting for a loved one to arrive before they can go peacefully. There are even those who seem to wait just long enough to be left entirely alone before passing on.

But eventually, the conclusion of this interaction is death. Ideally, I’ve guided my patient (and their soul, I feel) through to the next era of their existence peacefully, comfortably, and in the setting/manner of their own choosing. I’m not even going to begin to describe what I think that “era” 
is, nor what it involves. I could write volumes guessing. But what I do know is this: terminal illness does NOT equate to powerlessness. Healthcare professionals treating terminal patients must actively work to empower their patients. Sitting in that room, listening to memory after memory from a hospice nurse, I was moved. These patients cannot choose not to die. (At some point along the way, nor can we.) But we can all choose how we would like to live… no matter how long we may or may not have left. There is nothing I perceive as more humbling than being able to not only ease someone through the dying process, but empower them through it. It is a role that, pending one last semester and a passing grade on my NCLEX exam, will humbly and graciously fulfill… perhaps for the rest of my days, if I so choose.

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