What I am learning
I have read some books on death and dying and on hospice nursing, since this is a new arena for me, and many of them say that we are constantly learning from our patients, that we need to remember that and be aware of what this person is trying to teach us.
I am learning that I should never assume that something is attributed to something else just because it seems to be, don't make assumptions, consider other possibilities. One lady I cared for had a change in her medicine and shortly after began choking and being unable to swallow. We thought it was the medicine, or I did, the Dr told me don't assume. She died shortly after presumably from a stroke, so it quite possibly was not the medicine, but indeed some kind of neurological event. However, sometimes things are exactly what they seem, you never know.
I am learning that if there is anyway possible, help a dying person with their dying wish. Someone I was caring for dies yesterday, and she had had to move from her home of many years as she was increasingly unsafe in her home, and no one could stay there to care for her. She looked like she was dying earlier this week, and probably was, but Friday she began to get agitated, even getting up and walking around trying to get her shoes on, begging us to take her to her home. She said, "I could sleep, if I could just get into my own bed". We couldn't do it and she was wearing out her caregiver, her family her friends, no one could go sit with her. We sent her to the hospital to get her meds changed and calm her down enough to return to the foster home, but as soon as her head hit the sheets there, she died. I know we have no idea how long someone has, but if we knew that this was her dying wish, could we have found a way to get her home for the night? Probably.
I am learning that when people are getting close, they really do see loved ones who have died before them. I asked one family if their dying family member had seen any people who had died, and the mom said her son was talking to a family member who had died. People go on, and when they are close to dying, they seem to have one foot here and one foot there. It doesn't seem to be scary, what they see seems benign or loving. One mom got upset when I asked if her son was hallucinating, she said "he isn't crazy you know". I said, hallucination is just a word we use for something one person can see that another person can't. I am not making judgements, but if someone is perceiving something we aren't, medical science can't explain that, they have to call it something.
I am learning that death is inevitable. It will happen. Sometimes people don't want it and other times people long for it, it doesn't happen fast enough. Either way, peoples lives wind down as they should and as they will. I used to worry about doing something that would kill someone, making a mistake. That makes it hard to be a nurse, and it always haunted me. I feel better about that, I have realized that people are pretty durable, (but I still hate central lines, they seem so invasive, so direct, like sending an arrow to the heart). Yuck. Anyway, I see people endure amazing amounts of abuse and keep ticking. Other people slip away for no apperant reason. I think we as medical professionals have the power to help, but in the end, we aren't as powerful as we think. We can't keep a person alive whose time has come to go or who simply has lost the will to go on. We might delay it by a few hours or days, but we don't really change the outcome by much. People seem to know what they need, and what they want, and you have to let them direct the process. We might think a certain thing is best but it doesn't matter at all if the patient disagrees, they will do what they want, we have to respect that.
That's a lot in a couple of months.
I am learning that I should never assume that something is attributed to something else just because it seems to be, don't make assumptions, consider other possibilities. One lady I cared for had a change in her medicine and shortly after began choking and being unable to swallow. We thought it was the medicine, or I did, the Dr told me don't assume. She died shortly after presumably from a stroke, so it quite possibly was not the medicine, but indeed some kind of neurological event. However, sometimes things are exactly what they seem, you never know.
I am learning that if there is anyway possible, help a dying person with their dying wish. Someone I was caring for dies yesterday, and she had had to move from her home of many years as she was increasingly unsafe in her home, and no one could stay there to care for her. She looked like she was dying earlier this week, and probably was, but Friday she began to get agitated, even getting up and walking around trying to get her shoes on, begging us to take her to her home. She said, "I could sleep, if I could just get into my own bed". We couldn't do it and she was wearing out her caregiver, her family her friends, no one could go sit with her. We sent her to the hospital to get her meds changed and calm her down enough to return to the foster home, but as soon as her head hit the sheets there, she died. I know we have no idea how long someone has, but if we knew that this was her dying wish, could we have found a way to get her home for the night? Probably.
I am learning that when people are getting close, they really do see loved ones who have died before them. I asked one family if their dying family member had seen any people who had died, and the mom said her son was talking to a family member who had died. People go on, and when they are close to dying, they seem to have one foot here and one foot there. It doesn't seem to be scary, what they see seems benign or loving. One mom got upset when I asked if her son was hallucinating, she said "he isn't crazy you know". I said, hallucination is just a word we use for something one person can see that another person can't. I am not making judgements, but if someone is perceiving something we aren't, medical science can't explain that, they have to call it something.
I am learning that death is inevitable. It will happen. Sometimes people don't want it and other times people long for it, it doesn't happen fast enough. Either way, peoples lives wind down as they should and as they will. I used to worry about doing something that would kill someone, making a mistake. That makes it hard to be a nurse, and it always haunted me. I feel better about that, I have realized that people are pretty durable, (but I still hate central lines, they seem so invasive, so direct, like sending an arrow to the heart). Yuck. Anyway, I see people endure amazing amounts of abuse and keep ticking. Other people slip away for no apperant reason. I think we as medical professionals have the power to help, but in the end, we aren't as powerful as we think. We can't keep a person alive whose time has come to go or who simply has lost the will to go on. We might delay it by a few hours or days, but we don't really change the outcome by much. People seem to know what they need, and what they want, and you have to let them direct the process. We might think a certain thing is best but it doesn't matter at all if the patient disagrees, they will do what they want, we have to respect that.
That's a lot in a couple of months.
posted by madmom at 9:28 AM
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