Tuesday, January 24, 2012

Death as a Process

When someone dies, it is not uncommon to spend time thinking back to the process that led to the event. More often than not, the actual process of dying began months before that person took their last breath.

This process of subtle changes is crucial to recognize, as it allows for early intervention with hospice services.  Early hospice enrollment is important because is means better quality of living and often longer life.

Unfortunately, there isn’t much emphasis in the medical world to look for signs of dying. Death so often can seem like defeat that no one wants to acknowledge it, let alone to actually go looking for it. The irony is, once acknowledged, it doesn’t lead to defeat, but gentle acceptance; which in turn leads to a focus on living ones remaining life to its fullest.

The other key is to understand that death is not just a moment. Today’s advanced medications, therapies and interventions have led to the ability to control and extend chronic diseases. While this is wonderful, there is still a time when the body begins to fail despite our interventions. This change is often missed as we mask the inevitable by adding one more pill or doing one more procedure.

The biggest clue that dying has in fact begun involves medical crises. When Mrs. C had her first heart surgery, the recovery was tough, but she did very well. She was able to get back to volunteering regularly and enjoyed spending time with her grandchildren.  Her second medical crisis, 8 years later, however was not as smooth.

This time after surgery she had complications. These did resolve, but she never quite regained her previous strength. Two months later, another problem arose, this time with her kidneys. Treatments were aggressive and eventually her numbers looked good, but she had lost a bit more strength. Over the next several months, setback after setback occurred. She began a revolving cycle of time in the hospital, followed by rehab, then home, and back to the hospital again. Each cycle she lost more strength and ultimately her will to live.

Mrs. C continued with minor crises, until one afternoon she had a major heart attack. At the hospital the decision was made for hospice, though Mrs. C was no longer responsive.

When did dying begin for Mrs. C.? It was likely months before the word hospice was first mentioned. When the treatments for each medical crisis didn’t bring her back to her prior level of function, and the rate of each medical crisis seemed to come sooner and sooner, this was the white flag her body waved as a sign that the process had begun.

The sad thing is Mrs. C was never told the process had started. She therefore never spent the time reconnecting with her grandchildren, or writing out those stories from her childhood. She just hoped the next medical intervention would turn things around.

Though it didn’t happen for Mrs. C, if we can put away our fears and start talking about patterns associated with dying, we can help others focus on living better.

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