This I Believe

Douglas - Fremont, California
Entered on July 28, 2007
Age Group: 50 - 65
Themes: death

I believe in a “good” death. After 25 years as a critical care nurse, I have observed and been involved with hundreds, even thousands of dying patients. The typical experience does not resemble a good death.

Most intensive care units are harsh. They are noisy, rushed and technical. Dying patients often linger on respirators with tubes and lines everywhere. Anxiety, painful procedures and institutional routines often become the norm. I have seen patients literally deteriorating by inches.

Though healthcare workers do their best to ease pain and suffering, their jobs become increasingly difficult because at some point, Death will not yield. Despite our best efforts we slowly lose the battle. When we look back, sometimes we ask ourselves, “Why did we do all those things to terminal patients?” I think of these as bad deaths.

Surprisingly, a good death used to be more common because the technology did not exist to prolong suffering. Dying used to occur at home with family around, and death occurred naturally. We did not make unreasonable attempts that only prolonged suffering. There is a reason that pneumonia used to be called “the old person’s friend”. Pneumonia used to gently ease the frail and exhausted person into death.

I have come to think there may be a better way to think of death. Perhaps it is the last chapter in a long story. Like so many good books, that last chapter holds within the summing-up, reconciliation and proper closure. The final stage of life is valuable. Patients can say their good byes and conclude life business. Unreasonable and painful interventions that have little chance of success can be avoided. The dying person gains some control over how they conclude life.

Yet I see barriers in our culture. We avoid confronting our mortality. We refrain from talking about the “D” word. We have unreasonable expectations. Sometimes we expect miracles. Increasingly, I see people who think of death as not being an “option.” These barriers leave little room for a thoughtful, high quality end-of-life experience.

Despite the barriers, I have certainly seen good deaths in our unit and have helped patients by listening and using any resources available. The core of being a nurse has drawn me to try to make things better, if only in little ways. A quiet room, gentle music, bending the rules on limitation of visitors; I have even conspired to bring a beloved dog to the bedside.

As I work in the hospital environment everyday, I can’t help thinking about what my own good death will be like. I hope I can avoid the barriers. One can’t know for sure, but I hope to be home surrounded by close friends and family. Farewells are important. I will be in my bed with my view to the hills nearby. And my family knows to bring my dogs to my bed for one final hug. I wouldn’t want to leave them without saying goodbye.