We are not talking about death. But if you do this, you increase your chances of going gentle into that good night.
People of a certain age: As you clean out closets and put together your will, remember to clearly state your end-of-life health preferences.
Dr. Mat Philip said that for many people, death is a highly reactive, chaotic process that adds stress to the patient and family.
“Many of the things people want to happen at the end of life don’t actually happen for a variety of reasons, primarily absence,” said the internal medicine physician and senior vice president of Appropriate Health and Care and Value-Based Care. have a plan.
“Research shows that 80 percent of people want to die at home,” he said. But only 20 to 25 percent actually do so, he said.
He said our healthcare system generally passively refers people to hospitals as they approach the end of life. If you don’t want this to happen, you need to have a clear conversation about your wishes, Philip said.
“Even before you get diagnosed, talk to your loved ones,” she said. “If there is any terminal diagnosis, notify your healthcare provider as well and create a practical plan for how this could work.”
Sure, it can be an uncomfortable conversation, but normalizing it can be very helpful for patients, family members and healthcare providers, he said.
When there is no plan, patients and family members struggle with what they think others want or expect. When a dying person is not treated as they would like, stress and anxiety increase, which can increase the pain, he said.
An advance directive can ensure that you and your loved ones experience the end of life in the calmest, most empowering way possible, he said.
In the hospital setting, he said: “They have more tubes and wires that they’re hooked up to, more invasive things like blood draws and being woken up in the middle of the night to check vitals. And a lot of people are put on tubes like ventilators and other things. The end result is that last precious moment with their family.” “They can’t interact with them in those moments. It can really take up their time and it’s also really disruptive for them.”
As a doctor who works with many high-risk patients, Philip said, “I’ve seen this happen many times.”
Once the dying process begins, family caregivers must enlist the help of someone outside the immediate family to handle hygiene and medications, Philip said. This way, he said, the caregiver can focus solely on being the husband, son or daughter.
“Hospice can really help right now,” she said. Can help guide discussions and answer questions. Patients who know little about hospice tend to have a negative feeling about it, Philip said. But patients who are familiar with it are much more positive about it. It is important to know what hospice is and what it is not.
Hospice care is specifically for patients nearing the end of life. Rather than focusing on treatment, it provides comfort and tries to improve the person’s quality of life.
For example, if we are transitioning to a higher quality of life, Philip said: “The patient should be able to eat what he wants, because it is about maximizing the quality of time he has left. So even if they eat a traditionally low-salt diet, it doesn’t matter at the end of their lives; We are not striving for longevity.”
But he added: “Don’t force them to eat. Dying patients may have difficulty eating, which can lead to choking, which can cause anxiety.
“After all, the body knows it’s time. Energy needs decrease, people begin to eat and drink less. “One of the gentlest ways is to shut down the kidneys because people fall into a kind of comfortable sleep,” he said.
Knowing this can influence the types of medications you want or don’t want to take at the end of life, he said. The same can be said for treatments such as chemotherapy, he said. If the drug does not improve a dying patient’s quality of life, they may choose to stop the drug, he said.
“I have a friend who never wants to be put on a ventilator. He ended up in one, and some of his loved ones nearly had him in a long-term facility. But he was very clear that he didn’t want that, and his other loved ones were able to accommodate his wish,” Philip said.
“I try to prepare my patients for this. Families come back again and again and thank me for helping them prepare. They say, ‘We were able to be there and pray together and say everything we wanted to say.’ It’s been like a gift,” he said.
Pamela Palmer is the care pastor at Good Shepherd Church in Naperville. She also served as a hospital chaplain for 10 years.
“It is imperative that people are not alone in death or any suffering. Loneliness increases pain,” Palmer said. “Companionship does not eliminate pain or the fear of death, but it can be a source of comfort.”
Palmer added that there are emotional, spiritual and physical ways to calm someone who is dying or suffering at the end of life.
“Physical contact such as sitting next to the person’s bed, holding hands, hugging, giving a back or foot massage, or lying next to the person can bring peace,” she said. “So can hearing (familiar) voices or being spoken to, reading Scripture or favorite books, praying for that person, singing or playing music.”
When Palmer’s grandmother was dying, family and friends “would hug her and hold her hands. We would sit on the floor next to his bed and play games while he watched, talking to him, telling him what we were doing, involving him as much as possible. “It gave him happiness and comfort that we were nearby and that he was still as engaged in our family’s life as possible.”
Palmer also recommends caregivers join support groups, seek professional counseling, or find a trusted friend, pastor, or mentor they can talk to and walk their journey with.
“The difficulties they experience with care are legitimate and the costs this may entail must be taken into account,” he said.
Ultimately, both Palmer and Philip say, much of the anxiety often associated with death can be alleviated through early conversation.
“When family members know they are honoring their loved one’s wishes, there is a sense of closure,” Philip said. “There is a strikingly different outcome and memory.”
“It’s worth planning and discussing it,” he said, adding: You can take things further by planning your own funeral, or even purchasing your headstone, so your loved ones don’t have to do it while they’re in grief.
Donna Vickroy is an award-winning reporter, editor and columnist who worked for the Daily Southtown for 38 years.